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Sample records for coronary artery development

  1. Coronary artery aneurysms

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    Koischwitz, D.; Harder, T.; Schuppan, U.; Thurn, P.

    1982-04-01

    Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed. Coronary artery aneurysms have a poor prognosis because of the possibility of rupture with resultant cardiac tamponade, or the development of thrombo-embolic myocardial infarction. These aneurysms can only be diagnosed by means of coronary angiography and require appropriate treatment.

  2. Coronary Artery Anomalies in Animals

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    Brian A. Scansen

    2017-04-01

    Full Text Available Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.

  3. Aggressive nonsurgical management of acute coronary artery occlusions developing immediately after percutaneous transluminal coronary angioplasty (PTCA)

    International Nuclear Information System (INIS)

    Levin, D.C.; Meyerovitz, M.; Boxt, L.; Taus, R.; Ganz, P.; Friedman, P.; Selwyn, A.

    1986-01-01

    In 368 consecutive percutaneous transluminal coronary angiography (PTCA) procedures, acute occlusion of the dilated artery developed within the first hour after the procedure in 24 cases (6.5%). Four patients underwent emergency bypass surgery. In 17 of the remaining 20 patients, repeat balloon dilation was immediately attempted, and was successful in 11 instances (65%). Five of the six cases in which repeat balloon dilation was not successful responded well to surgical or medical therapy. The author conclude that acute occlusions of dilated coronary arteries shortly after PTCA do not automatically necessitate emergency bypass. Approximately two thirds of such cases can be managed by repeat dilation, converting a potential complication into a successful outcome

  4. Development of Coronary Pulse Wave Velocity: New Pathophysiological Insight Into Coronary Artery Disease.

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    Harbaoui, Brahim; Courand, Pierre-Yves; Cividjian, Andrei; Lantelme, Pierre

    2017-02-02

    Although aortic stiffness assessed by pulse wave velocity (PWV) is a strong predictor of coronary artery disease, the significance of local coronary stiffness has never been tackled. The first objective of this study was to describe a method of measuring coronary PWV (CoPWV) invasively and to describe its determinants. The second objective was to assess both CoPWV and aortic PWV in patients presenting with acute coronary syndromes or stable coronary artery disease. In 53 patients, CoPWV was measured from the delay in pressure wave and distance traveled as a pressure wire was withdrawn from the distal to the proximal coronary segment. Similarly, aortic PWV was measured invasively when the wire was pulled across the ascending aorta; carotid-femoral PWV was also measured noninvasively using the SphygmoCor system (AtCor Medical). Mean CoPWV was 10.3±6.1 m/s. Determinants of increased CoPWV were fractional flow reserve, diastolic blood pressure, and previous stent implantation in the recorded artery. CoPWV was lower in patients with acute coronary syndromes versus stable coronary artery disease (7.6±3 versus 11.5±6.4 m/s; P=0.02), and this persisted after adjustment for confounders. In contrast, aortic stiffness, assessed by aortic and carotid-femoral PWV, did not differ significantly. CoPWV seems associated with acute coronary events more closely than aortic PWV. High coronary compliance, whether per se or because it leads to a distal shift in compliance mismatch, may expose vulnerable plaques to high cyclic stretch. CoPWV is a new tool to assess local compliance at the coronary level; it paves the way for a new field of research. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  5. Congenital coronary artery fistula

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    Oh, Yeon Hee; Kim, Hong; Zeon, Seoc Kil; Suh, Soo Jhi

    1986-01-01

    Congenital coronary artery fistula (CCAF) is communication of a coronary artery or its main branch with one of the atria or ventricles, the coronary sinus, the superior vena cava, or the pulmonary artery. In Korean peoples, only 4 cases of the CCAF were reported as rare as worldwide and authors want to report another case of CCAF, confirmed by operation. 10-year-old girl shows a fistula between sinus node artery of the right coronary artery and right atrium on root aortogram with left-to-right shunt and Qp/Qs=1.58, in which simple ligation of the sinus node artery from right coronary artery was performed. All of the 5 Korean CCAF (4 were previously reported and 1 of authors) were originated from right coronary artery, and of which 4 were opening into right ventricle and 1 of authors were into right atrium. Associated cardiac anomaly was noted in only 1 case as single coronary artery. Ages were from 9 months of age to 10 years old and no adult left case were found. 3 were female and 2 were male patients.

  6. Physiologic assessment of coronary artery fistula

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    Gupta, N.C.; Beauvais, J. (Creighton Univ., Omaha, NE (USA))

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.

  7. Physiologic assessment of coronary artery fistula

    International Nuclear Information System (INIS)

    Gupta, N.C.; Beauvais, J.

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery

  8. Development of bilateral coronary artery aneurysms in a child with Noonan syndrome

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    Mauro, David M.; Flors, Lucia; Norton, Patrick T.; Hagspiel, Klaus D.; Hoyer, Andrew W.

    2016-01-01

    Noonan syndrome is a constellation of congenital malformations including heart defects, facial anomalies and short stature. The cardiovascular defects are variable and extensive, with the most common being pulmonary stenosis and hypertrophic cardiomyopathy. Coronary artery anomalies have only been reported in a few cases. We report a child with Noonan syndrome status post pulmonary stenosis and atrial septal defect repair, who developed bilateral coronary artery aneurysms. The aneurysms were diagnosed with both cardiac magnetic resonance imaging and coronary computed tomography angiography. There had been no evidence of them on a cardiac MR exam 5 years previously. (orig.)

  9. Development of bilateral coronary artery aneurysms in a child with Noonan syndrome

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    Mauro, David M.; Flors, Lucia; Norton, Patrick T.; Hagspiel, Klaus D. [University of Virginia Health System, Department of Radiology and Medical Imaging, Charlottesville, VA (United States); Hoyer, Andrew W. [University of Virginia Health System, Department of Pediatrics, Division of Pediatric Cardiology, Charlottesville, VA (United States); Pediatric Cardiology Center of Oregon, Portland, OR (United States)

    2016-03-15

    Noonan syndrome is a constellation of congenital malformations including heart defects, facial anomalies and short stature. The cardiovascular defects are variable and extensive, with the most common being pulmonary stenosis and hypertrophic cardiomyopathy. Coronary artery anomalies have only been reported in a few cases. We report a child with Noonan syndrome status post pulmonary stenosis and atrial septal defect repair, who developed bilateral coronary artery aneurysms. The aneurysms were diagnosed with both cardiac magnetic resonance imaging and coronary computed tomography angiography. There had been no evidence of them on a cardiac MR exam 5 years previously. (orig.)

  10. [Endarterectomy of the coronary arteries].

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    Fischer, V; Simkovic, I; Holoman, M; Verchvodko, P; Janotík, P; Galbánek, J; Hulman, M; Kostelnicák, J; Jurco, R; Slezák, J

    1992-02-01

    The authors analyze 50 patients with endarterectomy of the coronary arteries during the periods of 1972-1974 and 1988-1990. The results of endarterectomy of the right and left coronary artery provide evidence of its justification in indicated cases whereby contrary to some departments the results of endarterectomy of the left coronary artery are comparable with endarterectomy of the right coronary artery.

  11. Coronary artery fistula

    Science.gov (United States)

    ... PA: Elsevier Saunders; 2015:chap 84. Friedman AH, Silverman NH. Congenital anomalies of the coronary arteries. In: ... provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the ...

  12. Development of a model of the coronary arterial tree for the 4D XCAT phantom

    International Nuclear Information System (INIS)

    Fung, George S K; Tsui, Benjamin M W; Segars, W Paul; Gullberg, Grant T

    2011-01-01

    A detailed three-dimensional (3D) model of the coronary artery tree with cardiac motion has great potential for applications in a wide variety of medical imaging research areas. In this work, we first developed a computer-generated 3D model of the coronary arterial tree for the heart in the extended cardiac-torso (XCAT) phantom, thereby creating a realistic computer model of the human anatomy. The coronary arterial tree model was based on two datasets: (1) a gated cardiac dual-source computed tomography (CT) angiographic dataset obtained from a normal human subject and (2) statistical morphometric data of porcine hearts. The initial proximal segments of the vasculature and the anatomical details of the boundaries of the ventricles were defined by segmenting the CT data. An iterative rule-based generation method was developed and applied to extend the coronary arterial tree beyond the initial proximal segments. The algorithm was governed by three factors: (1) statistical morphometric measurements of the connectivity, lengths and diameters of the arterial segments; (2) avoidance forces from other vessel segments and the boundaries of the myocardium, and (3) optimality principles which minimize the drag force at the bifurcations of the generated tree. Using this algorithm, the 3D computational model of the largest six orders of the coronary arterial tree was generated, which spread across the myocardium of the left and right ventricles. The 3D coronary arterial tree model was then extended to 4D to simulate different cardiac phases by deforming the original 3D model according to the motion vector map of the 4D cardiac model of the XCAT phantom at the corresponding phases. As a result, a detailed and realistic 4D model of the coronary arterial tree was developed for the XCAT phantom by imposing constraints of anatomical and physiological characteristics of the coronary vasculature. This new 4D coronary artery tree model provides a unique simulation tool that can be

  13. Breast arterial calcifications are correlated with subsequent development of coronary artery calcifications, but their aetiology is predominantly different

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    Maas, Angela H.E.M. [Department of Cardiology, Isala Klinieken, Groot Wezenland 20, 8011 JW Zwolle (Netherlands)], E-mail: a.maas@diagram-zwolle.nl; Schouw, Yvonne T. van der; Atsma, Femke [Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht (Netherlands); Beijerinck, David; Deurenberg, Jan J.M. [Preventicon Breast Cancer Screening Center, Stationsplein 91, 3511ED Utrecht (Netherlands); Mali, Willem P.Th.M. [Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht (Netherlands); Graaf, Y. van der [Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht (Netherlands)

    2007-09-15

    Objective: To study whether calcifications in breast arteries, as seen on mammograms, predict future development of coronary artery calcifications. Methods: We studied 499 women, aged 49-70 years, participating in a breast cancer screening program and investigated whether arterial calcifications in the breast (BAC) are associated with coronary arterial calcifications (CAC) after 9 years follow-up. Mammograms were reviewed for the presence of BAC. CAC was assessed by multi slice computed tomography (MSCT). With logistic regression analysis the independent effect of various risk factors on BAC and CAC was measured. Results: BAC was present in 58 of 499 women (12%) and CAC score > 0 was present in 262 of 499 women (53%). BAC was strongly associated with CAC (OR 3.2, 95% CI 1.71-6.04) and this remained significant after adjustment for age at baseline and the duration of follow-up (OR 2.1, 95% CI 1.10-4.23). Most CV risk factors were associated with CAC but not with BAC. Only parity was significantly associated with both increased CAC (OR 2.1, 95% CI 1.21-3.60) and increased BAC (OR 5.3, 95% CI 1.23-22.43). Breastfeeding was associated with BAC (OR 3.4, 95% CI 1.40-8.23) but not with CAC (OR 1.3, 95% CI 0.84-1.93). Conclusion: Breast arterial calcifications are predictive of subsequent development of calcifications in the coronary arteries.

  14. COVERED STENTS IN IATROGENIC CORONARY ARTERY FISTULA; A CASE REPORT

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    Masoud Poormoghaddas

    2010-11-01

    Full Text Available Abstract    BACKGROUND: Coronary artery fistula is an abnormal communication between a coronary artery and a cardiac chamber or major cardiac vessels, mostly congenital but some of them are acquired as a consequence of coronary artery perforation.    CASE PRESENTATION: We report a case of cavity spilling coronary artery perforation during percutaneous coronary intervention 7 years ago. Because of continuing symptoms and risk of developing heart failure and pulmonary hypertension we were ought to treat this iatrogenically formed coronary artery fistula. We used stent graft implantation to treat it with acceptable results.    CONCLUSION: Beside their application as a rescue for acute coronary artery perforations, stent grafts can be used with acceptable results in iatrogenically acquired coronary artery coronary artery fistula      Keywords: Coronary artery perforation, Coronary artery fistula, Stent graft.

  15. Coronary Artery Bypass in Octogenarians

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    Chen-Yen Chien

    2012-09-01

    Full Text Available Prevalence of coronary artery disease (CAD has increased with the expansion of life span among the elderly population in the world. Hence, the issue of the coronary artery bypass in octogenarians has attracted more attention. Recent literature about the topic revealed nearly the same excellent results as those in the younger population under the newly developed operative techniques and improving concept in perioperative management and postoperative care. In this article, we review the current status of the procedure that was thought to be dangerous in the earlier era, including its risk factors, result, and benefit.

  16. Coronary Artery Disease

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    Christiansen, Morten Krogh

    2017-01-01

    A family history of coronary artery disease (CAD) is an important risk factor for adverse coronary events, in particular if the disease has an early onset. The risk of CAD is influenced by genetic and environmental factors with a greater genetic contribution earlier in life. Through recent years......), and to characterize and quantify subclinical atherosclerosis in their relatives. Furthermore, the aim was to explore the impact of common genetic risk variants on the age of onset, familial clustering and disease severity. In study I, 143 patients with early- onset CAD were recruited from the Western Denmark Heart...... Registry and risk factor control was evaluated. The study revealed that risk factors are common in early-onset CAD and that a large room for risk factor improvement remains. In study II, we used coronary computed tomography angiography to compare the coronary plaque burden and characteristics between 88...

  17. Single Coronary Artery with Aortic Regurgitation

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    Katsetos, Manny C.; Toce, Dale T.

    2003-01-01

    An isolated single coronary artery can be associated with normal life expectancy; however, patients are at an increased risk of sudden death. A case is reported of a 54-year-old man with several months of chest pressure with activity. On exercise Sestamibi stress testing, the patient developed a hypotensive response with no symptoms and minimal electrocardiographic changes. Nuclear scanning demonstrated reversible septal and lateral perfusion defects consistent with severe ischemia. Coronary angiography revealed a single coronary artery with the right coronary artery arising from the left main. There were high-grade stenotic lesions in the left anterior descending and circumflex arteries with only moderate atherosclerotic disease in the right coronary artery. An aortogram showed 2-3+ aortic regurgitation, with an ejection fraction of 45% on ventriculography. The patient underwent four-vessel revascularization and aortic valve replacement and did well postoperatively

  18. Coronary artery anatomy and variants

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    Malago, Roberto; Pezzato, Andrea; Barbiani, Camilla; Alfonsi, Ugolino; Nicoli, Lisa; Caliari, Giuliana; Pozzi Mucelli, Roberto [Policlinico G.B. Rossi, University of Verona, Department of Radiology, Verona (Italy)

    2011-12-15

    Variants and congenital anomalies of the coronary arteries are usually asymptomatic, but may present with severe chest pain or cardiac arrest. The introduction of multidetector CT coronary angiography (MDCT-CA) allows the detection of significant coronary artery stenosis. Improved performance with isotropic spatial resolution and higher temporal resolution provides a valid alternative to conventional coronary angiography (CCA) in many patients. MDCT-CA is now considered the ideal tool for three-dimensional visualization of the complex and tortuous anatomy of the coronary arteries. With multiplanar and volume-rendered reconstructions, MDCT-CA may even outperform CCA in determining the relative position of vessels, thus providing a better view of the coronary vascular anatomy. The purpose of this review is to describe the normal anatomy of the coronary arteries and their main variants based on MDCT-CA with appropriate reconstructions. (orig.)

  19. Blood pressure reactivity to psychological stress and coronary calcification in the Coronary Artery Risk Development in Young Adults Study.

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    Matthews, Karen A; Zhu, Sha; Tucker, Diane C; Whooley, Mary A

    2006-03-01

    A longstanding hypothesis is that individuals who exhibit large increases in blood pressure during psychological stress are at risk for atherosclerosis. We tested whether blood pressure changes during psychological stress predict subsequent coronary calcification (CaC) in young healthy adults. We evaluated 2816 healthy black and white women, 20 to 35 years of age, from the Coronary Artery Risk Development in Young Adults Study, who were not using medication for hypertension or diabetes in 1987-1988. Participants completed video game and star tracing tasks while their blood pressure was recorded. Thirteen years later (2000-2001), they completed computed tomography measures of CaC. Overall 9.3% (261 of 2816) had CaC present at follow-up. Each 10 mm Hg change in systolic blood pressure during the video game was associated with a 24% increased odds of having CaC at follow-up (unadjusted odds ratio, 1.24; 95% CI, 1.06 to 1.46; P=0.008). This association persisted after adjustment for age, race, sex, education, smoking, alcohol, family history of myocardial infarction, smoking, daily alcohol consumption, body mass index, and resting or baseline blood pressure (odds ratio, 1.31; 95% CI, 1.08 to 1.58; P=0.006). Blood pressure changes during the star tracing task were not associated with subsequent CaC. Blood pressure changes during a video game predicted the presence of CaC 13 years later. To our knowledge, this is the first study that reports blood pressure reactivity to a stressor being related to calcification in the coronary arteries. Blood pressure reactivity may provide useful prognostic information about future risk beyond standard risk factors.

  20. Nanomedicine in coronary artery disease.

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    Ambesh, Paurush; Campia, Umberto; Obiagwu, Chukwudi; Bansal, Rashika; Shetty, Vijay; Hollander, Gerald; Shani, Jacob

    Nanomedicine is one of the most promising therapeutic modalities researchers are working on. It involves development of drugs and devices that work at the nanoscale (10-9m). Coronary artery disease (CAD) is responsible for more than a third of all deaths in age group >35 years. With such a huge burden of mortality, CAD is one of the diseases where nanomedicine is being employed for preventive and therapeutic interventions. Nanomedicine can effectively deliver focused drug payload at sites of local plaque formation. Non-invasive strategies include thwarting angiogenesis, intra-arterial thrombosis and local inflammation. Invasive strategies following percutaneous coronary intervention (PCI) include anti-restenosis and healing enhancement. However, before practical application becomes widespread, many challenges need to be dealt with. These include manufacturing at the nanoscale, direct nanomaterial cellular toxicity and visualization. Copyright © 2017 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  1. BAF200 is required for heart morphogenesis and coronary artery development.

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    Lingjuan He

    Full Text Available ATP-dependent SWI/SNF chromatin remodeling complexes utilize ATP hydrolysis to non-covalently change nucleosome-DNA interactions and are essential in stem cell development, organogenesis, and tumorigenesis. Biochemical studies show that SWI/SNF in mammalian cells can be divided into two subcomplexes BAF and PBAF based on the subunit composition. ARID2 or BAF200 has been defined as an intrinsic subunit of PBAF complex. However, the function of BAF200 in vivo is not clear. To dissect the possible role of BAF200 in regulating embryogenesis and organ development, we generated BAF200 mutant mice and found they were embryonic lethal. BAF200 mutant embryos exhibited multiple cardiac defects including thin myocardium, ventricular septum defect, common atrioventricular valve, and double outlet right ventricle around E14.5. Moreover, we also detected reduced intramyocardial coronary arteries in BAF200 mutants, suggesting that BAF200 is required for proper migration and differentiation of subepicardial venous cells into arterial endothelial cells. Our work revealed that PBAF complex plays a critical role in heart morphogenesis and coronary artery angiogenesis.

  2. Calcified Plaque of Coronary Artery: Factors Influencing Overestimation of Coronary Artery Stenosis on Coronary CT Angiography

    International Nuclear Information System (INIS)

    Kim, Mok Hee; Kim, Yun Hyeon; Choi, Song; Seon, Hyun Ju; Jeong, Gwang Woo; Park, Jin Gyoon; Kang, Heoung Keun; Ko, Joon Seok

    2010-01-01

    To assess the influence of calcified plaque characteristics on the overestimation of coronary arterial stenosis on a coronary CT angiography (CCTA). The study included 271 coronary arteries with calcified plaques identified by CCTA, and based on 928 coronary arteries from 232 patients who underwent both CCTA and invasive coronary angiography (ICA). Individual coronary arteries were classified into two groups by agreement based on the degree of stenosis from each CCTA and ICA: 1) group A includes patients with concordant CCTA and ICA results and, 2) group B includes patients with an overestimation of CCTA compared to ICA. Parameters including total calcium score, calcium score of an individual coronary artery, calcium burden number of an individual coronary artery, and the density of each calcified plaque (calcium score / number of calcium burden) for each individual coronary artery were compared between the two groups. Of the 271 coronary arteries, 164 (60.5%) were overestimated on CCTA. The left anterior descending artery (LAD) had a significantly low rate of overestimation (47.1%) compared to the other coronary arteries (p=0.001). No significant differences for total calcium score, calcium score of individual coronary artery, and the density of each calcified plaque from individual coronary arteries between two groups was observed. However, a decreasing tendency for the rate of overestimation on CCTA was observed with an increase in calcium burden of individual coronary arteries (p<0.05). The evaluation of coronary arteries suggests that the degree of coronary arterial stenosis had a tendency to be overestimated by calcified plaques on CCTA. However, the rate of overestimation for the degree of coronary arterial stenosis by calcified plaques was not significantly influenced by total calcium score, calcium score of individual coronary artery, and density of each calcified plaque

  3. Radiation-induced coronary artery disease

    International Nuclear Information System (INIS)

    Dunsmore, L.D.; LoPonte, M.A.; Dunsmore, R.A.

    1986-01-01

    This report describes three patients who developed myocardial infarction at an untimely age, 4 to 12 years after radiation therapy for Hodgkin's disease. These cases lend credence to the cause and effect relation of such therapy to coronary artery disease

  4. Prospective association of polycystic ovary syndrome with coronary artery calcification and carotid-intima-media thickness: the Coronary Artery Risk Development in Young Adults Women's study.

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    Calderon-Margalit, Ronit; Siscovick, David; Merkin, Sharon S; Wang, Erica; Daviglus, Martha L; Schreiner, Pamela J; Sternfeld, Barbara; Williams, O Dale; Lewis, Cora E; Azziz, Ricardo; Schwartz, Stephen M; Wellons, Melissa F

    2014-12-01

    To study the independent associations of polycystic ovary syndrome (PCOS), and its 2 components, hyperandrogenism and anovulation, with coronary artery calcification (CAC) and carotid artery intima-media thickness (IMT). At the year 20 of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based multicenter cohort of young adults, women (mean age, 45 years) with information on menses and hirsutism in their twenties were assessed for CAC (n=982) and IMT (n=988). We defined PCOS as women who had both irregular menses and hyperandrogenism (n=55); isolated oligomenorrhea (n=103) as women who only had irregular menses; and isolated hyperandrogenism (n=156) as women who had either hirsutism or increased testosterone levels. Logistic regressions and general linear models were used to estimate the associations between components of PCOS and subclinical CVD. The prevalence of CAC was 10.3% overall. Women with PCOS had a multivariable adjusted odds ratio of 2.70 (95% confidence interval, 1.31-5.60) for CAC. Women with either isolated oligomenorrhea or isolated hyperandrogenism had no increased risk of CAC when compared with unexposed women. Women with PCOS had significantly increased bulb and internal carotid-IMT measurements; however, no significant differences were noted in bulb or internal carotid artery IMT among women with either isolated oligomenorrhea or isolated hyperandrogenism when compared with unexposed women. There were no differences in common carotid-IMT among the 4 study groups. In this study, women with PCOS, manifested as both anovulation and hyperandrogenism, but not women with one of these manifestations alone, were at increased risk for the development of subclinical CVD. © 2014 American Heart Association, Inc.

  5. [Minimally invasive coronary artery surgery].

    Science.gov (United States)

    Zalaquett, R; Howard, M; Irarrázaval, M J; Morán, S; Maturana, G; Becker, P; Medel, J; Sacco, C; Lema, G; Canessa, R; Cruz, F

    1999-01-01

    There is a growing interest to perform a left internal mammary artery (LIMA) graft to the left anterior descending coronary artery (LAD) on a beating heart through a minimally invasive access to the chest cavity. To report the experience with minimally invasive coronary artery surgery. Analysis of 11 patients aged 48 to 79 years old with single vessel disease that, between 1996 and 1997, had a LIMA graft to the LAD performed through a minimally invasive left anterior mediastinotomy, without cardiopulmonary bypass. A 6 to 10 cm left parasternal incision was done. The LIMA to the LAD anastomosis was done after pharmacological heart rate and blood pressure control and a period of ischemic pre conditioning. Graft patency was confirmed intraoperatively by standard Doppler techniques. Patients were followed for a mean of 11.6 months (7-15 months). All patients were extubated in the operating room and transferred out of the intensive care unit on the next morning. Seven patients were discharged on the third postoperative day. Duplex scanning confirmed graft patency in all patients before discharge; in two patients, it was confirmed additionally by arteriography. There was no hospital mortality, no perioperative myocardial infarction and no bleeding problems. After follow up, ten patients were free of angina, in functional class I and pleased with the surgical and cosmetic results. One patient developed atypical angina on the seventh postoperative month and a selective arteriography confirmed stenosis of the anastomosis. A successful angioplasty of the original LAD lesion was carried out. A minimally invasive left anterior mediastinotomy is a good surgical access to perform a successful LIMA to LAD graft without cardiopulmonary bypass, allowing a shorter hospital stay and earlier postoperative recovery. However, a larger experience and a longer follow up is required to define its role in the treatment of coronary artery disease.

  6. MRI in coronary artery disease

    International Nuclear Information System (INIS)

    Barkhausen, Joerg; Hunold, Peter; Waltering, Kai-Uwe

    2004-01-01

    Diagnosis of coronary artery disease (CAD) is a major challenge for medical imaging, because CAD is the leading cause of death in developed nations. Several non-invasive tests are used in clinical routine for the detection of CAD. However, due to limited sensitivity and specificity, the reliable diagnosis as well as the exclusion of CAD can only be established by catheter angiography. In patients with known CAD, therapeutic decisions require accurate information on myocardial function, ischemia and viability. Recently, magnetic resonance (MR) imaging has emerged as a non-invasive cardiac imaging technique that provides information on cardiac morphology, cardiac function, myocardial viability, and coronary morphology. This review discusses technical aspects and the clinical impact of different MR techniques. (orig.)

  7. Management of coronary artery disease

    Science.gov (United States)

    Safri, Z.

    2018-03-01

    Coronary Artery Disease (CAD) is associated with significant morbidity and mortality, therefore it’s important to early and accurate detection and appropriate management. Diagnosis of CAD include clinical examination, noninvasive techniques such as biochemical testing, a resting ECG, possibly ambulatory ECG monitoring, resting echocardiography, chest X-ray in selected patients; and catheterization. Managements of CAD patients include lifestyle modification, control of CAD risk factors, pharmacologic therapy, and patient education. Revascularization consists of percutaneous coronary angioplasty and coronary artery bypass grafting. Cardiac rehabilitation should be considered in all patients with CAD. This comprehensive review highlights strategies of management in patients with CAD.

  8. Coronary artery dissection following chest trauma

    Directory of Open Access Journals (Sweden)

    Manoj K Agarwala

    2016-01-01

    Full Text Available Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.

  9. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M-C. Morice (Marie-Claude); A.P. Kappetein (Arie Pieter); A. Colombo (Antonio); D.R. Holmes Jr (David); M.J. Mack (Michael); E. Stahle (Elisabeth); T.E. Feldman (Ted); M.J.B.M. van den Brand (Marcel); E.J. Bass (Eric); N. van Dyck (Nic); K. Leadly (Katrin); K.D. Dawkins (Keith); F.W. Mohr (Friedrich)

    2009-01-01

    textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating

  10. Impact of insulin like growth factor-1 in development of coronary artery ectasia

    Directory of Open Access Journals (Sweden)

    Ibrahim Faruk Akturk

    2014-09-01

    Full Text Available Coronary artery ectasia (CAE is characterized by inappropriate dilatation of the coronary vasculature. The mechanisms of CAE are not well known. Insulin-like growth factor-1 (IGF-1 may make endothelial cells and smooth muscle cells more sensitive to the effects of growth hormone. In the present study, we hypothesized that IGF-1 may have an impact on the formation of ectasia and aneurysm in arterial system, and aimed to investigate the associations between the presence of CAE and serum IGF-1 levels in patients undergoing coronary angiography. The study included 2.980 subjects undergoing elective diagnostic coronary angiography. We selected 40 patients diagnosed with CAE as CAE group and 44 subjects with absolutely normal coronary arteries were assigned as normal control group. IGF-1 levels were measured in both groups of patients. Groups were similar in terms of age, sex and coronary artery disease risk factors. The serum IGF-1 levels were significantly higher in CAE patients with 109.64±54.64 ng/mL than in controls with 84.76±34.01 ng/mL (p=0.016. HDL levels were lower in ectasia group with 41.5±10.7 mg/dL than controls with 47.7±10.4 mg/dL (p=0.018. By means of logistic regression analysis, high IGF-1 and low HDL levels were found to be independent risk factors for the presence of CAE (p<0.02, p<0.016, respectively. The study revealed that there was a positive correlation between serum IGF-1 levels and presence of CAE, and high IGF-1 levels and low HDL levels were independent risk factors for the presence of CAE. Future studies are needed to confirm these results.

  11. Coronary artery with aberrant origin malignant right

    International Nuclear Information System (INIS)

    Ozcan, E.; Bozlar, U.; Demirkol, S.; Saglam, M.

    2012-01-01

    Full text: Introduction: Congenital anomalies of the coronary arteries is a major cause of sudden death, especially in young patients. Objectives and tasks: In this study we aim to present a young patient with chest pain who had malignant right coronary artery (RCA) with aberrant origin. Materials and methods: 24-year-old man who applied cardiology clinic for chest pain and palpitations especially after exercise, was referred to our clinic for coronary computed tomography (CT) angiography to evaluate coronary artery anomalies. Results: In CT angiography; we detected aberrant RCA with origin of tubularly part of ascendant aorta with a malignant course between aorta and pulmonary artery. Left main coronary artery, left anterior descending and circumflex artery had normal origin and course. Conclusion: Coronary artery with malignant course may cause sudden death especially after exercise. Coronary CT angiography has an important role in diagnosis of congenital coronary artery anomalies, with high resolution multiplanner reformatted images

  12. Development of smartphone educational application for patients with coronary artery disease.

    Science.gov (United States)

    Cho, Min Jung; Sim, Jae Lan; Hwang, Seon Young

    2014-04-01

    This study was conducted to develop a smartphone application (app) as an educational learning instrument for coronary artery disease (CAD) patients and to assess the users' level of satisfaction. This methodological research involves elicited learning content for CAD patients to develop a learning instrument using the smartphone app. The app was developed according to the steps of Assessment, Design, Development, Implementation, and Evaluation, which is a systematic instructional design model. The levels of satisfaction with the developed smartphone app among 30 outpatients with CAD were assessed via a questionnaire during their visits to a cardiology outpatient department. A smartphone app 'Strong Heart' was developed through reviewing the literature associated with education for CAD patients under professional supervision and searching for medical smartphone apps that are already available. The learning contents include six main sections containing essential learning issues in managing CAD and additional information to attract the user's attention, such as patient cases and quizzes. After modification with feedback from experts, the app was finally developed and evaluated by patients who reported that they were satisfied with the usefulness of the app. The developed smartphone app is available on both the iPhone App Store and the Android Play Store. Patients with CAD may utilize the app for supporting educational material without limitations of time and space.

  13. Acute Thrombotic Coronary Occlusion in a Patient with Coronary Artery Anomaly

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    Beganu Elena

    2017-09-01

    Full Text Available Patients with coronary artery anomalies are more susceptible to develop acute thrombotic coronary occlusions due to the abnormal anatomy of these arteries and the disturbance of the pathophysiological mechanisms that lead to an accelerated atherosclerosis development. The following article presents the case of a 64-year-old female patient diagnosed with anterior ST-segment elevation myocardial infarction. The patient underwent primary percutaneous coronary intervention, which revealed the absence of the right coronary artery and separated origins of the left anterior descending artery and the left circumflex artery from the aorta.

  14. Anomalous origin of right coronary artery from left coronary sinus.

    Science.gov (United States)

    Hamzeh, Gadah; Crespo, Alex; Estarán, Rafael; Rodríguez, Miguel A; Voces, Roberto; Aramendi, José I

    2008-08-01

    Anomalous aortic origin of the coronary arteries is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe 4 patients, aged 34 to 59 years, who were diagnosed with right coronary artery arising from the left sinus of Valsalva, confirmed by coronary angiography, which was surgically repaired. Three patients presented dyspnea and angina, and one with acute myocardial infarction. At operation, the right coronary artery was dissected at the take-off from the intramural course, and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated coronary artery disease that required stent placement postoperatively. This reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives superior results to coronary artery bypass grafting or the unroofing technique.

  15. Body Mass Index and Subjective Social Status: The Coronary Artery Risk Development in Young Adults Study.

    Science.gov (United States)

    Dhurandhar, Emily J; Pavela, Gregory; Kaiser, Kathryn A; Dutton, Gareth R; Fontaine, Kevin R; Kim, Daniel; Shikany, James M; Allison, David B; Lewis, Cora E

    2018-02-01

    Subjective social status (SSS), or perceived social status, may explain, in part, the relationship between socioeconomic status (SES) and obesity. The objective of this study was to test whether SSS mediates the relationship between two indicators of SES (income and education) and body mass index (BMI). A cross-sectional, structural equation path analysis was applied to the Coronary Artery Risk Development in Young Adults (CARDIA) study (n = 2,624). The analysis tested whether SSS (MacArthur scale), education, and income were associated with BMI at the year 20 examination (adjusting for sex, age, and race), and it was hypothesized that the associations of education and income with BMI would be at least partly mediated by SSS. SSS had a significant direct effect on BMI (-0.21, P = 0.018). Education had a significant direct relationship with SSS (0.11, P SSS (-0.02, P = 0.022). Although income did not have a significant direct relationship with BMI, it did have a significant indirect relationship through SSS (b = -0.05, P = 0.019). Results are consistent with the hypothesized model in which SSS partially mediates the relationship between SES indicators and BMI. © 2017 The Obesity Society.

  16. Haptoglobin phenotypes as a risk factor for coronary artery disease ...

    African Journals Online (AJOL)

    Haptoglobin phenotypes as a risk factor for coronary artery disease in type 2 ... Recognition of diabetic individuals at greatest risk of developing coronary artery ... CAD, Group II: 48 type 2DM patients with developed CAD, Group III: 40 age and ...

  17. Successful treatment of coronary artery pseudoaneurysm by graft stent, which developed after the implantation of bare metal stent

    Directory of Open Access Journals (Sweden)

    Utku Şenol

    2013-03-01

    Full Text Available Although coronary artery pseudoaneurysm which couldoccur following percutaneous coronary interventions is arare complication, it can be mortal. As soon as the pseudoaneurysmis diagnosed, it should be treated by percutaneousintervention or surgery. Graft stent implantationis a preferred treatment for appropriate patients. In thiscase report, we presented a successful treatment of coronaryartery pseudoaneurysm by graft stent; which developedafter the implantation of bare metal stent into theleft anterior descending coronary artery. J Clin Exp Invest2013; 4 (1: 126-129Key words: Coronary artery, pseudoaneurysm, graft stent

  18. Diabetes mellitus and female gender are the strongest predictors of poor collateral vessel development in patients with severe coronary artery stenosis.

    Science.gov (United States)

    Yetkin, Ertan; Topal, Ergun; Erguzel, Nuri; Senen, Kubilay; Heper, Gulumser; Waltenberger, Johannes

    2015-04-01

    Coronary collateral vessel development (CVD), i.e., arteriogenesis, is regarded as one of the most important mechanisms—along with angiogenesis—to result in protection of the myocardium. Coronary CVD is associated with a reduction in infarct size, future cardiovascular events and improved survival in patients with occlusive coronary artery disease by enhancing regional perfusion in the chronically ischemic myocardium. In the present study, we aimed to investigate the relation of cardiovascular risk factors and hematological parameters with collateral development in patients with severely stenotic (≥95%) and totally occluded coronary artery disease including at least one major coronary artery. The study population was selected from the patients who underwent coronary angiography between January 2008 and March 2009. Five hundred and two patients who had at least one coronary artery stenosis ≥95% (368 men; mean age 59 ± 10 years) comprised the study population. Of the 502 patients, 228 had total occlusion in at least one major epicardial coronary artery. Collateral artery grading was performed by using Cohen-Rentrop method to the vessel with coronary artery stenosis of ≥95% and patients with chronic total occlusions (CTO). Patients with grade 0-1 collateral development were regarded as the poor collateral group, and patients with grade 2-3 collateral development were regarded as the good collateral group. Two hundred and fifty-eight (51%) of 502 patients had poor collateral development, and 244 (49%) had good collateral development. Logistic regression analysis revealed that DM was independently associated with poor CVD in patients with ≥95% stenosis (p risk factor for poor CVD in addition to DM in patients with CTO.

  19. Coronary artery anomalies in Turner Syndrome.

    Science.gov (United States)

    Viuff, Mette H; Trolle, Christian; Wen, Jan; Jensen, Jesper M; Nørgaard, Bjarne L; Gutmark, Ephraim J; Gutmark-Little, Iris; Mortensen, Kristian H; Gravholt, Claus Højbjerg; Andersen, Niels H

    Congenital heart disease, primarily involving the left-sided structures, is often seen in patients with Turner Syndrome. Moreover, a few case reports have indicated that coronary anomalies may be more prevalent in Turner Syndrome than in the normal population. We therefore set out to systematically investigate coronary arterial anatomy by computed tomographic coronary angiography (coronary CTA) in Turner Syndrome patients. Fifty consecutive women with Turner Syndrome (mean age 47 years [17-71]) underwent coronary CTA. Patients were compared with 25 gender-matched controls. Coronary anomaly was more frequent in patients with Turner Syndrome than in healthy controls [20% vs. 4% (p = 0.043)]. Nine out of ten abnormal cases had an anomalous left coronary artery anatomy (absent left main trunk, n = 7; circumflex artery originating from the right aortic sinus, n = 2). One case had a tubular origin of the right coronary artery above the aortic sinus. There was no correlation between the presence of coronary arterial anomalies and karyotype, bicuspid aortic valve, or other congenital heart defects. Coronary anomalies are highly prevalent in Turner Syndrome. The left coronary artery is predominantly affected, with an absent left main coronary artery being the most common anomaly. No hemodynamically relevant coronary anomalies were found. Copyright © 2016 Society of Cardiovascular Computed Tomography. All rights reserved.

  20. Progress in genetics of coronary artery disease

    African Journals Online (AJOL)

    Radwa Gamal

    To the Editor. Coronary Heart Disease (CHD) is the leading cause of mortality and morbidity worldwide [1] and it is a result of coronary artery disease (CAD). Coronary artery disease refers to the build-up of atherosclerotic plaque in the blood vessels that supply oxygen and nutrients to the heart. Progressive infiltration of the ...

  1. Development and Evaluation of Care Programs for the Delirium Management in Patients after Coronary Artery Bypass Graft Surgery (CABG

    Directory of Open Access Journals (Sweden)

    Safoora Fallahpoor

    2016-07-01

    Full Text Available Delirium is one of the common problems of cognitive impairment after coronary artery bypass graft surgery (CABG that its prevention, timely detection, and treatment require a care and management program to be controlled. The present research has studied a care program for the management of delirium in patients after coronary artery bypass graft surgery. This research was performed by action research methodology during a fivestage cycle in two groups of 50 persons (without interference and with intervention. In both groups, the patients were evaluated every 8 hours by CAM-ICU tool in hours (6, 14 and 22 for the occurrence of delirium after surgery until they were in Intensive Care Unit (ICU. In the intervention group, the developed program was implemented in three areas of delirium management before, during, and after the surgery. Then, the collected information was analyzed in two groups using descriptive and analytical statistics in SPSS 20 software. Delirium was observed at least once in 68% of patients without the intervention and 38% of patients with intervention after surgery. The ratio of delirium incidence was significantly lower in the intervention group (P<0.05. In addition, the total number of delirium in ICU was significantly lower for patients in the intervention group (P<0.05.The developed program for reducing the incidence of delirium in hospitalized patients after coronary artery bypass graft surgery (CABG was confirmed. This means that its applying will lead to a reduction in delirium.

  2. A rare anomaly: Double right coronary artery

    Directory of Open Access Journals (Sweden)

    Dursun Çayan Akkoyun

    2013-01-01

    Full Text Available Coronary artery anomalies are rare anomalies. Theseare usually asymptomatic and are discovered incidentally.Double right coronary artery (RCA is a rare coronaryartery anomaly. Although there is controversy aboutidentification and classification of double RCA, it is oftena benign condition, but it can be complicated by atherosclerosisand can lead to serious conditions such asmyocardial infarction (MI and may be accompanied byother anomalies. In our case, double RCA were detectedin coronary angiography for acute anterior MI, and in thenext session successful percutaneous coronary interventionwas performed.Key words: Coronary anomaly, coronary angiography,coronary stenosis

  3. Gender differences in the prevalence of coronary artery tortuosity and its association with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Joseph Chiha

    2017-03-01

    Conclusion: There is a significant relationship between coronary artery tortuosity and gender. Women with severe tortuosity are more likely to have normal coronary arteries or less severe disease than men despite presenting with chest pain.

  4. Circulating Cellular Adhesion Molecules and Cognitive Function: The Coronary Artery Risk Development in Young Adults Study

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    Cynthia Yursun Yoon

    2017-05-01

    Full Text Available ObjectiveHigher circulating concentrations of cellular adhesion molecules (CAMs can be used as markers of endothelial dysfunction. Given that the brain is highly vascularized, we assessed whether endothelial function is associated with cognitive performance.MethodWithin the Coronary Artery Risk Development in Young Adults (CARDIA Study, excluding N = 54 with stroke before year 25, we studied CAMs among N = 2,690 black and white men and women in CARDIA year 7 (1992–1993, ages 25–37 and N = 2,848 in CARDIA year 15 (2000–2001, ages 33–45. We included subjects with levels of circulating soluble CAMs measured in year 7 or 15 and cognitive function testing in year 25 (2010–2011, ages 43–55. Using multiple regression analysis, we evaluated the association between CAMs and year 25 cognitive test scores: Rey Auditory Verbal Learning Test (RAVLT, memory, Digit Symbol Substitution Test (DSST, speed of processing, and the Stroop Test (executive function.ResultAll CAM concentrations were greater in year 15 vs. year 7. Adjusting for age, race, sex, education, smoking, alcohol, diet, physical activity, participants in the fourth vs. the first quartile of CARDIA year 7 of circulating intercellular adhesion molecule-1 (ICAM-1 scored worse on RAVLT, DSST, and Stroop Test (p ≤ 0.05 in CARDIA year 25. Other CAMs showed little association with cognitive test scores. Findings were similar for ICAM-1 assessed at year 15. Adjustment for possibly mediating physical factors attenuated the findings.ConclusionHigher circulating ICAM-1 at average ages 32 and 40 was associated with lower cognitive skills at average age 50. The study is consistent with the hypothesis that endothelial dysfunction is associated with worse short-term memory, speed of processing, and executive function.

  5. Circulating Cellular Adhesion Molecules and Cognitive Function: The Coronary Artery Risk Development in Young Adults Study.

    Science.gov (United States)

    Yoon, Cynthia Yursun; Steffen, Lyn M; Gross, Myron D; Launer, Lenore J; Odegaard, Andrew; Reiner, Alexander; Sanchez, Otto; Yaffe, Kristine; Sidney, Stephen; Jacobs, David R

    2017-01-01

    Higher circulating concentrations of cellular adhesion molecules (CAMs) can be used as markers of endothelial dysfunction. Given that the brain is highly vascularized, we assessed whether endothelial function is associated with cognitive performance. Within the Coronary Artery Risk Development in Young Adults (CARDIA) Study, excluding N  = 54 with stroke before year 25, we studied CAMs among N  = 2,690 black and white men and women in CARDIA year 7 (1992-1993, ages 25-37) and N  = 2,848 in CARDIA year 15 (2000-2001, ages 33-45). We included subjects with levels of circulating soluble CAMs measured in year 7 or 15 and cognitive function testing in year 25 (2010-2011, ages 43-55). Using multiple regression analysis, we evaluated the association between CAMs and year 25 cognitive test scores: Rey Auditory Verbal Learning Test (RAVLT, memory), Digit Symbol Substitution Test (DSST, speed of processing), and the Stroop Test (executive function). All CAM concentrations were greater in year 15 vs. year 7. Adjusting for age, race, sex, education, smoking, alcohol, diet, physical activity, participants in the fourth vs. the first quartile of CARDIA year 7 of circulating intercellular adhesion molecule-1 (ICAM-1) scored worse on RAVLT, DSST, and Stroop Test ( p  ≤ 0.05) in CARDIA year 25. Other CAMs showed little association with cognitive test scores. Findings were similar for ICAM-1 assessed at year 15. Adjustment for possibly mediating physical factors attenuated the findings. Higher circulating ICAM-1 at average ages 32 and 40 was associated with lower cognitive skills at average age 50. The study is consistent with the hypothesis that endothelial dysfunction is associated with worse short-term memory, speed of processing, and executive function.

  6. Unusually Looped and Muzzled Branches of Right Coronary Artery

    Directory of Open Access Journals (Sweden)

    Anitha Guru

    2017-01-01

    Full Text Available Coronary artery disease (CAD is the major cause of death in developed countries as it accounts on an average for 1 of every 5 deaths. Morphological variations of coronary arterial system is one of the causative factor for CAD. Anatomical knowledge of all possible variant patterns of coronary arterial system is imperative in the diagnostic and therapeutic approach of CAD. We report here a rare branching pattern of right coronary artery (RCA. The origin of RCA was normal but the course and branching pattern of it were atypical. RCA was not occupying its usual position in atrioventricular (coronary sulcus and its course was incomplete. It gave a ventricular branch to right ventricle, which presented an unusual looping pattern. It terminated as right marginal artery following its muzzled appearance within the musculature of the ventricle.

  7. Cardiac tamponade and coronary artery pseudoaneurysm after brachial arterial embolectomy, possible role for an aberrant origin of the right coronary artery

    Directory of Open Access Journals (Sweden)

    Irit Stessman-Lande, MD

    2018-03-01

    Full Text Available A patient developed hemopericardium shortly after left brachial arterial embolectomy using an embolectomy catheter. Evaluation disclosed evolving pseudoaneurysm of the right coronary artery that was successfully managed by stenting. Misplacement of the embolectomy catheter within the coronary vessel was facilitated by an anomalous origin of the right coronary artery. This complication highlights the importance of correct insertion of the embolectomy catheter using the markers to avoid maladvancement and damage to central vessels.

  8. Diagnosis and therapy of coronary artery disease: Second edition

    International Nuclear Information System (INIS)

    Cohn, P.F.

    1985-01-01

    This book contains 18 selections. Some of the titles are: Nuclear cardiology; Diagnosis of acute myocardial infarction; Therapy of angina pectoris; Psychosocial aspects of coronary artery disease; Nonatherosclerotic coronary artery disease; and The epidemiology of coronary artery disease

  9. An elevated level of BNP in plasma is related to the development of good collateral circulation in coronary artery disease.

    Science.gov (United States)

    Xi, Wei-Wei; Cheng, Gang; Lv, Shumin; Gao, Qinqin; Bu, Gang; Zhou, Ying; Xu, Geng

    2011-12-01

    B-type natriuretic peptide (BNP) was recently demonstrated to be a potential stimulator of angiogenesis and arteriogenesis. The correlation between BNP level and collateral formation in patients with coronary artery disease (CAD) has not been reported. The study included 311 consecutive patients who underwent coronary angiography were divided into three groups according to coronary angiography and collateral formation: normal group (100 patients with normal coronary angiographic findings); poor collateral group (116 patients with at least one coronary stenosis of ≥75% without visible collateral circulation); and good collateral group (95 patients with at least one coronary stenosis of ≥75% with well-developed collateral circulation). Collateral score was analyzed using the Cohen-Rentrop classification. Plasma BNP levels were 45.77 ± 4.66 pg/ml, 116.40 ± 28.15 pg/ml, and 254.20 ± 42.85 pg/ml for patients in normal, poor collateral, and good collateral groups, respectively. Plasma BNP levels in the latter were significantly higher than in the normal group (p collateral group (p collateral group and poor collateral group when compared with left ventricular ejection fraction (LVEF), left ventricular dimensions at end diastole (LVEDd), age, severity of angiographic disease, and other cardiovascular risk factors. After adjustment in the multiple ordinal logistic regression model, plasma BNP levels showed a strong independent association with collateral Cohen-Rentrop score (χ(2 )= 5.636, OR = 1.002, 95% CI 1.000-1.004, p = 0.018). An elevated level of BNP in plasma is independently associated with collateral development; patients with good collaterals tend to have a higher BNP level.

  10. Congenital Absence of Left Circumflex Coronary Artery

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    Zahra Ansari

    2009-09-01

    Full Text Available Congenital absence of left circumflex artery is a rare congenitalanomaly of the coronary arteries. The prevalence of theanomaly in different studies ranges from 0.6% to 1.3%. Ofthese, 80% are benign and asymptomatic and 20% are clinicallyimportant. We report a 56-year-old man presented withacute resting chest pain who was diagnosed as having acuteanterolateral infarction accompanied by electrocardiographicchanges and elevated cardiac enzymes. Coronary angiographyin different views was conducted, however, no left circumflexartery was found. The territory supplied by the artery had beenperfused by the super dominant right coronary artery. Therewas no left circumflex coronary artery with anomalous origin.Sever stenosis of left anterior ascending artery superimposedto the absent left circumflex artery was presented as acute anterolateralinfarction. Although absence of the artery is mostlyconsidered as a benign condition, atherosclerotic lesions maybe more important in such cases because of diminished compensatingmechanisms.

  11. Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease

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    Toischer Karl

    2009-09-01

    Full Text Available Abstract Background Despite the existence of controversial debates on the efficiency of coronary endarterectomy (CE, it is still used as an adjunct to coronary artery bypass grafting (CABG. This is particularly true in patients with endstage coronary artery disease. Given the improvements in cardiac surgery and postoperative care, as well as the rising number of elderly patient with numerous co-morbidities, re-evaluating the pros and cons of this technique is needed. Methods Patient demographic information, operative details and outcome data of 104 patients with diffuse calcified coronary artery disease were retrospectively analyzed with respect to functional capacity (NYHA, angina pectoris (CCS and mortality. Actuarial survival was reported using a Kaplan-Meyer analysis. Results Between August 2001 and March 2005, 104 patients underwent coronary artery bypass grafting (CABG with adjunctive coronary endarterectomy (CE in the Department of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen. Four patients were lost during follow-up. Data were gained from 88 male and 12 female patients; mean age was 65.5 ± 9 years. A total of 396 vessels were bypassed (4 ± 0.9 vessels per patient. In 98% left internal thoracic artery (LITA was used as arterial bypass graft and a total of 114 vessels were endarterectomized. CE was performed on right coronary artery (RCA (n = 55, on left anterior descending artery (LAD (n = 52 and circumflex artery (RCX (n = 7. Ninety-five patients suffered from 3-vessel-disease, 3 from 2-vessel- and 2 from 1-vessel-disease. Closed technique was used in 18%, open technique in 79% and in 3% a combination of both. The most frequent endarterectomized localization was right coronary artery (RCA = 55%. Despite the severity of endstage atherosclerosis, hospital mortality was only 5% (n = 5. During follow-up (24.5 ± 13.4 months, which is 96% complete (4 patients were lost caused by unknown address 8 patients died (cardiac

  12. Diagnosis of coronary artery disease

    International Nuclear Information System (INIS)

    Pfisterer, M.; Gordon, D.; Battler, A.; Ashburn, W.; Froelicher, V.; Kantonsspital Basel

    1979-01-01

    In order to compare the three non-invasive exercise tests Ecg, Thallium myocardial perfusion imaging and radionuclide angiography in the diagnosis of coronary artery disease, the results of these tests in a consecutive series of 30 patients and 14 controls were analyzed. In all 88 symptom-limited exercise tests a significantly higher double product (heart rate x systolic blood pressure, mm Hg/min) was reached on a treadmill test (for Ecg and Thallium scintigraphy) as compared to the supine bicycle ergometer exercise (for radionuclide angiography): 243.1 +- 61.1 vs. 215.2 +- 46.5 x 10 2 (p [de

  13. The Association between Androgenic Hormone Levels and the Risk of Developing Coronary Artery Disease (CAD).

    Science.gov (United States)

    Allameh, Farzad; Pourmand, Gholamreza; Bozorgi, Ali; Nekuie, Sepideh; Namdari, Farshad

    2016-01-01

    The aim of the study was to evaluate the relationship between the serum levels of androgens and Coronary Artery Disease (CAD) in an Iranian population. Male individuals admitted to Tehran Heart Center and Sina Hospital, Tehran, Iran from 2011-2012 were categorized into CAD and control groups based on selective coronary angiography. Baseline demographic data, including age, BMI, diabetes, and a history of hypertension were recorded. Patients were also assessed for their serum levels of total testosterone, free testosterone, estradiol, dehydroepi and rosterone sulfate (DHEA-S), and Sex Hormone Binding Globulin (SHBG). Data analysis was carried out chi-square and ANOVA tests as well as logistic regression analysis. Two hundred patients were in the CAD group and 135 individuals in control group. In the CAD group, 69 had single-vessel disease, 49 had two-vessel diseases, and 82 had three-vessel diseases. Statistically significant differences were observed between the individuals in the two groups with respect to age (PCAD group; however, the serum level of SHBG was higher in the CAD group than in the control group (P=0.007). Results of the logistic regression analysis indicated that only age (P=0.042) and diabetes (P=0.003) had significant relationships with CAD. Although the serum levels of some of the androgens were significantly different between the two groups, no association was found between androgenic hormone levels and the risk of CAD, due mainly to the effect of age and diabetes.

  14. Coronary artery calcification in Kawasaki disease

    International Nuclear Information System (INIS)

    Ino, T.; Shimazaki, S.; Akimoto, K.; Park, I.; Nishimoto, K.; Yabuta, K.; Tanaka, A.

    1990-01-01

    To evaluate the angiographic features of coronary lesions in Kawasaki disease with coronary artery calcification, cinefluoroscopy and cineangiography were retrospectively reviewed in 116 patients who had undergone coronary angiography between 1982 and 1989. Angiographic abnormalities of coronary arteries were demonstrated in 55 of 116 patients. In 5 (9.1%) of the 55 patients, 9 with calcification were identified by cinefluoroscopy and chest X-ray. Eight of the 9 calcified lesions showed a circular or ring-shape configuration. Coronary angiography revealed a total occlusion of the right coronary artery with collateral circulation from the distal left coronary artery in 2 patients and a severe stenosis of the right coronary artery in 2 patients, in whom anticoagulant therapy had not been continued during the follow-up periods. The remaining patient in whom anticoagulant therapy had been continued had bilateral aneurysms but no significant stenosis. These results indicate that a ring-shape calcification on chest X-ray in 2 patients with a history of Kawasaki disease may suggest an involvement by coronary artery stenosis even when anticoagulant drugs had been given. Therefore, coronary angiography should be performed to evaluate the stenotic lesions if this type of calcification is found by routine radiographic examination. (orig.)

  15. Interesting images: Multiple coronary artery aneurysms.

    Science.gov (United States)

    Howard, Jonathon M; Viswanath, Omar; Armas, Alfredo; Santana, Orlando; Rosen, Gerald P

    2017-01-01

    We present the case of a 65-year-old male who presented with stable angina and dyspnea on exertion. His initial workup yielded a positive treadmill stress test for reversible apical ischemia, and transthoracic echocardiogram demonstrated impaired systolic function. Cardiac catheterization was then performed, revealing severe atherosclerotic disease including multiple coronary artery aneurysms. As a result, the patient was advised to and subsequently underwent a coronary artery bypass graft. This case highlights the presence of multiple coronary artery aneurysms and the ability to appreciate these pathologic findings on multiple imaging modalities, including coronary angiogram, transesophageal echocardiography, and direct visualization through the surgical field.

  16. Cardiogenic shock due to coronary artery disease associated with interrupted aortic arch

    Directory of Open Access Journals (Sweden)

    Luís Alberto Oliveira Dallan

    2013-06-01

    Full Text Available Acute pulmonary edema is a serious event. Its occurrence in association with interrupted aortic arch and coronary heart disease is rare. Recently, an old patient developed cardiogenic shock and acute pulmonary edema due to acute coronary insufficiency, associated with interrupted aortic arch. The coronary angiography revealed occlusion of the right coronary artery and 95% obstruction in the left main coronary artery, associated with interruption of the descending aorta. Coronary artery bypass graft was performed, without extracorporeal circulation, to the anterior descending coronary artery. We discuss the initial management, given the seriousness of the case.

  17. Ischemia and No Obstructive Coronary Artery Disease (INOCA): Developing Evidence-based Therapies and Research Agenda for the Next Decade

    Science.gov (United States)

    Merz, C. Noel Bairey; Pepine, Carl J.; Walsh, Mary Norine; Fleg, Jerome L.

    2017-01-01

    The Cardiovascular Disease in Women Committee of the American College of Cardiology, in conjunction with interested parties (from the National Heart, Lung, and Blood Institute, American Heart Association, European Society of Cardiology), convened a working group to develop a consensus on the syndrome of myocardial ischemia with no obstructive coronary arteries (INOCA). In general, these patients have elevated risk for a cardiovascular event (including acute coronary syndrome, heart failure hospitalization, stroke, and repeated cardiovascular procedures) vs reference subjects, and appear to be at higher risk for development of heart failure with preserved ejection fraction (HFpEF). A subgroup of these patients also has coronary microvascular dysfunction (CMD) and evidence of inflammation. This document provides a summary of findings and recommendations toward the development of an integrated approach for identifying and managing patients with INOCA, and outlining knowledge gaps in the area. Working group members critically reviewed available literature and current practices for risk assessment and state-of-the-science techniques in multiple areas, with a focus on next steps needed to develop evidence-based therapies. This report presents highlights of this working group review and a summary of suggested research directions to advance this field in the next decade. PMID:28289007

  18. Spontaneous Coronary Artery Dissection following Topical Hormone Replacement Therapy

    Directory of Open Access Journals (Sweden)

    Alexander L. Pan

    2012-01-01

    Full Text Available Spontaneous coronary artery dissection is a rare condition, usually presenting as an acute coronary syndrome, and is often seen in states associated with high systemic estrogen levels such as pregnancy or oral contraceptive use. While topical hormonal replacement therapy may result in increased estrogen levels similar to those documented with oral contraceptive use, there are no reported cases of spontaneous coronary dissection with topical hormonal replacement therapy. We describe a 53-year-old female who developed two spontaneous coronary dissections while on topical hormonal replacement therapy. The patient had no other risk factors for coronary dissection. After withdrawal from topical hormonal therapy, our patient has done well and has not had recurrent coronary artery dissections over a one-year follow-up period. The potential contributory role of topical hormonal therapy as a cause of spontaneous coronary dissection should be recognized.

  19. Prevalence of Risk Factors for Coronary Artery Disease in Southern ...

    African Journals Online (AJOL)

    (48.5 %), fatty food consumption (47.5 %), obesity (38 %) and smoking (37 %), respectively. Other less ... Keywords: Risk factors, Prevalence, Coronary artery disease, Diabetes, Southern Punjab ... developing world, including Pakistan [1]. The.

  20. Multislice CT imaging of anomalous coronary arteries

    International Nuclear Information System (INIS)

    Shi Heshui; Aschoff, Andrik J.; Brambs, Hans-Juergen; Hoffmann, Martin H.K.

    2004-01-01

    The purpose of the present study was to evaluate the role of 16 multislice computed tomography (MSCT) to identify the origin of anomalous coronary arteries and to confirm their anatomic course in relation to the great vessels. Accuracy of coronary artery disease (CAD) detection was a secondary aim and was tested with conventional angiograms (CA) serving as standard of reference. Two hundred and forty-two consecutive patients referred for noninvasive coronary CT imaging were reviewed for the study. Sixteen patients (6.6%) with anomalous coronary arteries were detected and included as the study group. MSCT and CA images were analyzed in a blinded fashion for accuracy of anomalous artery origin and path detection. Results were compared in a secondary consensus evaluation. Accuracy ratios to detect CAD with MSCT in all vessels were calculated. Coronary anomalies for all 16 patients were correctly displayed on MSCT. CA alone achieved correct identification of the abnormality in only 53% (P=0.016). Sensitivity and specificity of MSCT to detect significantly stenosed vessels was 90 and 92%. 16-MSCT is accurate to delineate abnormally branching coronary arteries and allows sufficiently accurate detection of obstructive coronary artery disease in distal branches. It should therefore be considered as a prime non-invasive imaging tool for suspected coronary anomalies. (orig.)

  1. Aneurysmal coronary artery disease: An overview

    Science.gov (United States)

    ElGuindy, Mohamed S.

    Aneurysmal coronary artery disease (ACAD) comprises both coronary artery aneurysms (CAA) and coronary artery ectasia (CAE). The reported prevalence of ACAD varies widely from 0.2 to 10%, with male predominance and a predilection for the right coronary artery (RCA). Atherosclerosis is the commonest cause of ACAD in adults, while Kawasaki disease is the commonest cause in children and adolescents, as well as in the Far East. Most patients are asymptomatic, but when symptoms do exist, they are usually related to myocardial ischemia. Coronary angiography is the mainstay of diagnosis, but follow up is best achieved using noninvasive imaging that does not involve exposure to radiation. The optimal management strategy in patients with ACAD remains controversial. Medical therapy is indicated for the vast majority of patients and includes antiplatelets and/or anticoagulants. Covered stents effectively limit further expansion of the affected coronary segments. Surgical ligation, resection, and coronary artery bypass grafting are appropriate for large lesions and for associated obstructive coronary artery disease. PMID:29564347

  2. [Single coronary artery and right aortic arch].

    Science.gov (United States)

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Coronary anomalies are mostly asymptomatic and diagnosed incidentally during coronary angiography or echocardiography. However, they must be taken into account in the differential diagnosis of angina, dyspnea, syncope, acute myocardial infarction or sudden death in young patients. The case is presented of two rare anomalies, single coronary artery originating from right sinus of Valsalva and right aortic arch, in a 65 year-old patient with atherosclerotic coronary artery disease treated percutaneously. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  3. Genetics of Coronary Artery Disease

    DEFF Research Database (Denmark)

    McPherson, Ruth; Tybjærg-Hansen, Anne

    2016-01-01

    Genetic factors contribute importantly to the risk of coronary artery disease (CAD), and in the past decade, there has been major progress in this area. The tools applied include genome-wide association studies encompassing >200,000 individuals complemented by bioinformatic approaches, including...... identified. Furthermore, a total of 202 independent signals in 109 loci have achieved a false discovery rate (qgenetic risk scores that can improve risk prediction beyond conventional risk...... have led to a broader understanding of the genetic architecture of CAD and demonstrate that it largely derives from the cumulative effect of multiple common risk alleles individually of small effect size rather than rare variants with large effects on CAD risk. Despite this success, there has been...

  4. In-Vitro Evaluation of Coronary Stents and 64-Detector-Row Computed Tomography Using a Newly Developed Model of Coronary Artery Stenosis

    International Nuclear Information System (INIS)

    Schlosser, T.; Scheuermann, T.; Ulzheimer, S.; Mohrs, O.K.; Kuehling, M.; Al brecht, P.E.; Voigtlaender, T.; Barkhausen, J.; Schmermund, A.

    2008-01-01

    Background: Stent implantation is the predominant therapy for non-surgical myocardial revascularization in patients with coronary artery disease. However, despite substantial advances in multidetector computed tomography (MDCT) coronary imaging, a reliable detection of coronary in-stent restenosis is currently not possible. Purpose: To examine the ability of 64-detector-row CT to detect and to grade in-stent stenosis in coronary stents using a newly developed ex-vivo vessel phantom with a realistic CT density pattern, artificial stenosis, and a thorax phantom. Material and Methods: Four different stents (Liberte and Lunar ROX, Boston Scientific; Driver, Medtronic; Multi-Link Vision, Guidant) were examined. The stents were placed on a polymer tube with a diameter of 2.5, 3.0, 3.5, or 4.0 mm. Different degrees of stenosis (0%, 30%, 50%, 70-80%) were created inside the tube. For quantitative analysis, attenuation values were measured in the non-stenotic vessel outside the stent, in the non-stenotic vessel inside the stent, and in the stenotic area inside the stent. The grade of stenosis was visually assessed by two observers. Results: All stents led to artificial reduction of attenuation, the least degree of which was found in the Liberte stent (11.3±10.2 HU) and the Multi-Link Vision stent (17.6±17.9 HU; P 0.25). Overall, the non-stenotic vessel was correctly diagnosed in 55.5%, the low-grade stenosis in 58.3%, the intermediate stenosis in 63.8%, and the high-grade stenosis in 80.5%. In the 3.0-, 3.5-, and 4.0-mm vessels, in none of the cases was a non-stenotic or low-grade stenotic vessel misdiagnosed as intermediate or high-grade stenosis. The average deviation from the real grade of stenosis was 0.40 for the Liberte stent, 0.46 for the Lunar ROX stent, 0.45 for the Driver stent, and 0.58 for the Multi-Link Vision stent. Conclusion: Our ex-vivo data show that non-stenotic stents and low-grade in-stent stenosis can be reliably differentiated from intermediate and

  5. Left Circumflex Coronary Artery Fistula Connected to the Right Bronchial Artery Associated with Bronchiectasis: Multidetector CT and Coronary Angiography Findings

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Kyung Jin; Choo, Ki Seok [Dept. of Radiology, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan (Korea, Republic of)

    2013-04-15

    Coronary to bronchial artery fistula is a rare vascular anomaly secondary to enlargement of pre-existing vascular anastomosis between the coronary and bronchial arteries. This occurs when there is a constant disturbance of the pressure equilibrium involving either coronary or broncho-pulmonary disorder. Localized bronchiectasis is the most common related condition in patients with a coronary to bronchial artery fistula. Herein, we report on a case of a large left circumflex coronary artery to right bronchial artery fistula associated with bronchiectasis.

  6. Anomalous left coronary artery from the pulmonary artery

    Science.gov (United States)

    ... anomalies of mitral valve. In: Sellke FW, del Nido PJ, Swanson SJ, eds. Sabiston and Spencer Surgery ... of the coronary arteries. In: Sellke FW, del Nido PJ, Swanson SJ, eds. Sabiston and Spencer Surgery ...

  7. Computerized analysis of coronary artery disease: Performance evaluation of segmentation and tracking of coronary arteries in CT angiograms

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Chuan, E-mail: chuan@umich.edu; Chan, Heang-Ping; Chughtai, Aamer; Kuriakose, Jean; Agarwal, Prachi; Kazerooni, Ella A.; Hadjiiski, Lubomir M.; Patel, Smita; Wei, Jun [Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109 (United States)

    2014-08-15

    Purpose: The authors are developing a computer-aided detection system to assist radiologists in analysis of coronary artery disease in coronary CT angiograms (cCTA). This study evaluated the accuracy of the authors’ coronary artery segmentation and tracking method which are the essential steps to define the search space for the detection of atherosclerotic plaques. Methods: The heart region in cCTA is segmented and the vascular structures are enhanced using the authors’ multiscale coronary artery response (MSCAR) method that performed 3D multiscale filtering and analysis of the eigenvalues of Hessian matrices. Starting from seed points at the origins of the left and right coronary arteries, a 3D rolling balloon region growing (RBG) method that adapts to the local vessel size segmented and tracked each of the coronary arteries and identifies the branches along the tracked vessels. The branches are queued and subsequently tracked until the queue is exhausted. With Institutional Review Board approval, 62 cCTA were collected retrospectively from the authors’ patient files. Three experienced cardiothoracic radiologists manually tracked and marked center points of the coronary arteries as reference standard following the 17-segment model that includes clinically significant coronary arteries. Two radiologists visually examined the computer-segmented vessels and marked the mistakenly tracked veins and noisy structures as false positives (FPs). For the 62 cases, the radiologists marked a total of 10191 center points on 865 visible coronary artery segments. Results: The computer-segmented vessels overlapped with 83.6% (8520/10191) of the center points. Relative to the 865 radiologist-marked segments, the sensitivity reached 91.9% (795/865) if a true positive is defined as a computer-segmented vessel that overlapped with at least 10% of the reference center points marked on the segment. When the overlap threshold is increased to 50% and 100%, the sensitivities were 86

  8. Development of radiolabelled compound using reactor producted RI - Evaluation of Ho-166 endovascular therapy to prevent restenosis after PTCA or stenting for occlusive coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chan Hee; Choi, Byung Il; Kim, Han Soo [Ajou University, Suwon (Korea)

    2000-04-01

    Occlusive coronary artery disease is managed successfully by percutaneous transfemoral coronary angioplasty (PTCA) or stenting with 95% success rate. However, restenosis after PTCA is not uncommon and the reported incidence of reocclusion is about 30 {approx} 40%. Therefore, the objective of the research was to develop endovascular brachytherapy using liquid form of Ho-166 in order to inhibit neointimal hyperplasia responsible for restenosis following PTCA or stenting. Our research was carried out in 3 stages: First stage - The effectiveness of radiation was confirmed by using animal model. Following over-sized balloon injury to rat carotid artery and porcine coronary artery, various external radiation doses were delivered. Second stage - For radiation dose distribution within the coronary artery and its surrounding tissues, Gafchromic film was used. In vitro dose distribution of Ho-166 utilizing water phantom and Gafchromic film was measured. Third stage - None uniform dose distribution from Ho-166 within the balloon caused by small air bubbles was eliminated by negative suction method. More accurate dose distribution was also possible using newly developed micrometer by our physicist. Limited number of human trial was performed without adverse effect. 40 refs. (Author)

  9. Updates in management of coronary artery disease

    International Nuclear Information System (INIS)

    Yang, Dong Heon; Chae, Shung Chull

    2005-01-01

    Coronary artery disease (CAD) has been increasing during the last decade and is the one of major causes of death. The management of patients with coronary artery disease has evolved considerably. There are two main strategies in the management of CAD, complementary, not competitive, each other; the pharmacologic therapy to prevent and treat CAD and the percutaneous coronary intervention (PCI) to restore coronary flow. Antiplatelet drugs and cholesterol lowering drugs have central roles in pharmacotherapy. Drug eluting stent (DES) bring about revolutional changes in PCL in the management of patients with ST segment elevation acute myocardial infarction (AMI), there has been a debate on the better strategy for the restoration of coronary flow. Thrombolytic therapy is widely available and easy to administer, whereas primary PCI is less available and more complex, but more complete. Recently published evidences in the pharmacologic therapy including antiplatelet and statin, and PCI including DES and reperfusion therapy in patients with ST segment elevation AMI were reviewed

  10. Updates in management of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Dong Heon; Chae, Shung Chull [Kyungpook National University Medical School, Daegu (Korea, Republic of)

    2005-02-15

    Coronary artery disease (CAD) has been increasing during the last decade and is the one of major causes of death. The management of patients with coronary artery disease has evolved considerably. There are two main strategies in the management of CAD, complementary, not competitive, each other; the pharmacologic therapy to prevent and treat CAD and the percutaneous coronary intervention (PCI) to restore coronary flow. Antiplatelet drugs and cholesterol lowering drugs have central roles in pharmacotherapy. Drug eluting stent (DES) bring about revolutional changes in PCL in the management of patients with ST segment elevation acute myocardial infarction (AMI), there has been a debate on the better strategy for the restoration of coronary flow. Thrombolytic therapy is widely available and easy to administer, whereas primary PCI is less available and more complex, but more complete. Recently published evidences in the pharmacologic therapy including antiplatelet and statin, and PCI including DES and reperfusion therapy in patients with ST segment elevation AMI were reviewed.

  11. Anomalous left the pulmonary dilemma coronary artery artery from a ...

    African Journals Online (AJOL)

    Anomalous origin ofthe left coronary artery from the pulmonary artery is an unusual congenital ... led us to review our experience of this anomaly over the past 10 years. During this .... New York: McGraw-Hill, 1978: 1345. 5. Bland EF, White PO, ...

  12. [Pregnancy and coronary artery dissection].

    Science.gov (United States)

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Acute myocardial infarction during pregnancy is associated with high maternal and fetal mortality. Coronary atherosclerosis is the most common cause due to an increase in the age of the patients and the association with cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, preeclampsia, and the existence of family history of coronary disease. However, thrombosis, coronary dissection or coronary vasospasms are other causes that may justify it. We report the case of a 33 weeks pregnant first-time mother, without cardiovascular risk factors, who presented an acute coronary event in the context of atherosclerotic disease and coronary dissection after percutaneous coronary intervention. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  13. Coronary artery to left ventricle fistula

    Directory of Open Access Journals (Sweden)

    Kumar Vivek

    2005-11-01

    Full Text Available Abstract Background Coronary cameral fistulas are an uncommon entity, the etiology of which may be congenital or traumatic. They involve abnormal termination of a coronary artery, usually the right coronary, into a cardiac chamber, usually the right ventricle. Case Presentation We describe a case of female patient with severe aortic stenosis and interventricular septal hypertrophy that underwent bioprosthetic aortic valve replacement with concomitant septal myectomy. On subsequent follow-up an abnormal flow traversing the septum into the left ventricle was identified and Doppler interrogation demonstrated a continuous flow, with a predominantly diastolic component, consistent with coronary arterial flow. Conclusion The literature on coronary cameral fistulas is reviewed and the etiology of the diagnostic findings discussed. In our patient, a coronary artery to left ventricle fistula was the most likely explanation secondary to trauma to the septal perforator artery during myectomy. Since the patient was asymptomatic at the time of diagnosis no intervention was recommended and has done well on follow-up.

  14. Coronary artery atherosclerosis associated with shift work in chemical plant workers by using coronary CT angiography.

    Science.gov (United States)

    Kang, WonYang; Park, Won-Ju; Jang, Keun-Ho; Kim, Soo-Hyeon; Gwon, Do-Hyeong; Lim, Hyeong-Min; Ahn, Ji-Sung; Moon, Jai-Dong

    2016-08-01

    The aim of this study was to investigate whether shift work is related to elevated risk of coronary artery disease (CAD) by determining the coronary artery calcium (CAC) score and the presence of coronary artery stenosis by using coronary artery CT angiography (CCTA). In this study, 110 male workers participated and underwent a CCTA examination for CAC scoring, which represents coronary artery plaque, and were evaluated for luminal stenosis. All of the participants were working in the same chemical plant, of whom 70 worked day shifts and 40 worked rotating shifts. In a multivariate logistic regression analysis, including age, smoking status, alcohol consumption, regular exercise and waist circumference, shift work was associated with a 2.89-fold increase in the odds of developing coronary plaque compared with day work (OR, 2.89; 95% CI 1.07 to 7.82). The association between shift work and coronary plaque was strong after adjustment for age, low-density lipoprotein cholesterol, hypertension and diabetes mellitus (OR, 2.92; 95% CI 1.02 to 8.33). In addition, the number of years of shift work employment was associated with coronary plaque. However, no association was found between shift work and coronary artery stenosis. Shift work could induce CAD onset via the atherosclerotic process, and shift work employment duration was associated with an increased risk of atherosclerosis in male workers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. CORONARY ARTERY FISTULA: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    MZ Chowdhury

    2007-01-01

    Full Text Available The prevalence of congenital abnormalities of coronary artery is about 2% of general population. Of these abnormalities 5% were related to coronary artery fistulae (CAF. We report a case of 66 year old diabetic woman who presented with retrosternal chest pain. Her chest pain was associated with exercise and progressively deteriorated over the last 6 months. Electrocardiography showed right bundle branch block and Echo Color Doppler revealed hypo kinetic lateral wall. Coronary angiogram detected nothing abnormal except an aberrant tortuous branch of left circumflex. CT scan revealed a calcified sac medial to the descended thoracic aorta. A contrast enhancement was also done. All these imaging impressions were suggestive of coronary-to-pulmonary fistula. Ibrahim Med. Coll. J. 2007; 1(1: 32-33

  16. HUMAN CORONARY ARTERIES- A STUDY BASED ON GROSS ANATOMY AND CORONARY CAST

    Directory of Open Access Journals (Sweden)

    Vijayamma K. N

    2018-01-01

    Full Text Available BACKGROUND Present study is an attempt to throw light upon the coronary arterial pattern, variations in arterial distribution and extent of intercoronary anastomosis and arterial preponderance in different age groups. MATERIALS AND METHODS Total of 115 hearts were made use for this study. Ninety hearts were dissected for the gross anatomical study of coronary arteries and 25 hearts including three fetal hearts were used for the coronary cast study. The right and left coronary arteries were traced from aortic sinus along the atrioventricular groove to the area of its termination. The atrial ventricular and septal branches were traced and looked for anastomosis. Coronary casts were prepared by injecting coloured liquid latex through the coronary ostia and the branching pattern and anastomosis were studied. The coronary arterial pattern, extent of distribution of its branches, arterial preponderance and variations were observed. RESULTS It was found that 73 % cases of SA nodal branch arise from right coronary artery and 27 % from circumflex branch of left coronary artery. SA node has dual blood supply from both coronary arteries in 4% cases. Right coronary preponderance was observed in 83% of cases and left coronary preponderance in 11 % cases, and balanced supply in 6% cases. Coronary cast was helpful to understand the branching pattern of vessels, and the anastomosis of small capillaries. It was also seen that all 11 % of left preponderance were seen in male hearts and all of the 31 female hearts dissected were right preponderant. CONCLUSION Coronary arteries are called end arteries functionally. Right coronary artery originates from anterior aortic sinus in all cases except one which takes origin from posterior left aortic sinus along with left coronary artery. Right coronary preponderance is observed in 83% cases. Left coronary artery branching pattern shows variability. Left coronary preponderance was observed in 11% and all cases are male

  17. Coronary Anomaly and Coronary Artery Fistula as Cause of Angina Pectoris with Literature Review

    Directory of Open Access Journals (Sweden)

    Jayanth Koneru

    2011-01-01

    Full Text Available Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA, and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options.

  18. Recurrent post-partum coronary artery dissection

    Directory of Open Access Journals (Sweden)

    Resnic Frederic S

    2010-10-01

    Full Text Available Abstract Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view.

  19. Hydroxychloroquine, a promising choice for coronary artery disease?

    Science.gov (United States)

    Sun, Lizhe; Liu, Mengping; Li, Ruifeng; Zhao, Qiang; Liu, Junhui; Yang, Yanjie; Zhang, Lisha; Bai, Xiaofang; Wei, Yuanyuan; Ma, Qiangqiang; Zhou, Juan; Yuan, Zuyi; Wu, Yue

    2016-08-01

    Coronary artery disease is a common disease that seriously threaten the health of more than 150 million people per year. Atherosclerosis is considered to be the main cause of coronary artery disease which begins with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including: smoking, high blood pressure, hypercholesterolemia, sedentary lifestyle, diabetes and insulin resistance. Once a coronary artery disease has developed, all patients need to be treated with long term standard treatment, including heart-healthy lifestyle changes, medicines, and medical procedures or surgery. Hydroxychloroquine, an original antimalarial drug, prevents inflammation caused by lupus erythematosus and rheumatoid arthritis. It is relatively safe and well-tolerated during the treatment. Since atherosclerosis and rheumatoid arthritis have resemble mechanism and increasing clinical researches confirm that hydroxychloroquine has an important role in both anti-rheumatoid arthritis and cardiovascular protection (such as anti-platelet, anti-thrombotic, lipid-regulating, anti-hypertension, hypoglycemia, and so on), we hypothesize that hydroxychloroquine might be a promising choice to coronary artery disease patients for its multiple benefits. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. The relationship between fasting blood glucose variability and coronary artery collateral formation in type 2 diabetes patients with coronary artery disease.

    Science.gov (United States)

    Cheng, Gang; Mahmoudi, Hilda; Chokshi, Binna; Fernandez, Marlena; Kazemi, Vahid; Lamaa, Nader

    2017-09-01

    Coronary collaterals are an alternative source of blood supply to ischemic myocardium. Well-developed coronary collateral arteries in patients with coronary artery disease (CAD) limit the size of acute myocardial infarction and improves survival. The aim of this study was to investigate the relationship between glycemic variability and coronary collateral formation in patients with type 2 diabetes mellitus and CAD. Consecutive patients undergoing percutaneous coronary intervention or coronary artery bypass grafting procedures were studied. Multivariate logistic regression models were used to examine the association between coronary artery collateral formation graded by Rentrope classification and glycemic variability, measured by coefficient variation of fasting blood glucose. In our study, we retrospectively enrolled 300 patients, of whom 239 were diabetic (age: 70.1±11.9, 56% men) and 61 were nondiabetic (age: 71.5±11.5, 72% men). Diabetic patients were further stratified as follows: those with poor coronary collateral artery development (n=171, age: 69.7±12.4, 55% men) and those with good coronary collateral artery development (n=68, age 71.1±10.8, 59% men) according to the Rentrope classification. Our findings did not show association between glycemic variability and coronary collateral vessels development after controlling for potential confounders (odds ratio: 2.51; 95% confidence interval: 0.57-11.03; P=0.22). The culprit lesion (≥75% stenosis) in the left anterior descending artery and the right coronary artery was more frequent in the good collateral group compared with the poor collateral group (66 vs. 50%, P=0.02; 63 vs. 45%, P=0.01 respectively). Glycemic variability is not associated with coronary collateral artery formation in patients with type 2 diabetes mellitus and CAD.

  1. CASE REPORT ALCAPA: The Al Capone of coronary artery anomalies

    African Journals Online (AJOL)

    CT coronary angiography has the benefit of being non-invasive and will also demonstrate the origin of the left coronary artery from the pulmonary artery. Anomalous origin of the other coronary vessels may also be identified. The retrograde flow from the LCA to the pulmonary artery is well depicted on MRI and is seen as a ...

  2. Spontaneous coronary artery dissection associated with apical hypertrophic cardiomyopathy

    International Nuclear Information System (INIS)

    Tuncer, M.; Gumrukcuoglu, H.A.; Ekim, H.; Gunes, Y.; Simsek, H.

    2010-01-01

    Apical hypertrophic cardiomyopathy (HCM) is a relatively uncommon inherited disease. Spontaneous coronary artery dissection (SCAD) is also uncommonly observed, which often occurs in pregnant or post partum women but is rare in men. This report describes a 38 years old man with apical hypertrophic cardiomyopathy who developed SCAD leading to acute inferior myocardial infarction. After emergent appendectomy operation at another hospital, he was immediately transferred to the Cardiology Department of our hospital due to acute myocardial infarction. He emergently underwent coronary angiography which showed a long dissection involving the right coronary. He underwent an emergent CABG with cardiopulmonary bypass. Postoperative recovery was uneventful and he was discharged. According to our knowledge, no case of spontaneous coronary artery dissection associated with apical hypertrophic cardiomyopathy unrelated to postpartum period or oral contraceptive use has been reported so far. (author)

  3. Acute occlusion of the coronary artery after transluminal balloon coronary angioplasty

    International Nuclear Information System (INIS)

    Savchenko, A.P.; Matchin, Yu.G.; Lyakishev, A.A.

    1995-01-01

    The research was aimed at elucidation of the relationship of the clinical and angiographic factors, on the one hand, and development of acute occlusion following transluminal balloon coronary angioplasty TBCA, on the other. TBCA was carried out in 162 patients. Eight (4.9 %) patients developed acute occlusion of the coronary artery, which was complicated by acute myocardial infarction in 50 % cases. 35 refs.; 4 tabs

  4. Anomalous Origin of Left Coronary Artery from Pulmonary Artery (ALCAPA)

    International Nuclear Information System (INIS)

    Younus, Z.; Ahmed, I.; Iftikhar, R.

    2013-01-01

    Anomalous origin of the left coronary artery from the pulmonary artery also recognized as Bland White Garland syndrome is a very rare congenital condition. A two-months old baby boy presented with dyspnoea for two weeks and a pansystolic murmur on auscultation. The base line investigations showed cardiomegaly and bilateral basal haze on X-ray chest. ECG showed ST elevation in leads l and AVl and echocardiography showed situs solitus, levocardia, hypokinetic intraventricular septum, ejection fraction of 30%, mitral regurgitation of grade-I and an anomalous origin of the left coronary artery from pulmonary artery was diagnosed. Patient was in left heart failure. It was rectified surgically by creating a transpulmonary tunnel (Takeuchi repair). Postoperative course was uneventful and he was finally discharged in stable condition. (author)

  5. Coronary artery disease in Bangladesh: A review

    Directory of Open Access Journals (Sweden)

    A.K.M. Monwarul Islam

    2013-07-01

    Full Text Available Coronary artery disease (CAD is an increasingly important medical and public health problem, and is the leading cause of mortality in Bangladesh. Like other South Asians, Bangladeshis are unduly prone to develop CAD, which is often premature in onset, follows a rapidly progressive course and angiographically more severe. The underlying pathophysiology is poorly understood. Genetic predisposition, high prevalence of metabolic syndrome and conventional risk factors play important role. Lifestyle related factors, including poor dietary habits, excess saturated and trans fat, high salt intake, and low-level physical activity may be important as well. Some novel risk factors, including hypovitaminosis D, arsenic contamination in water and food-stuff, particulate matter air pollution may play unique role. At the advent of the new millennium, we know little about our real situation. Largescale epidemiological, genetic and clinical researches are needed to explore the different aspects of CAD in Bangladesh.

  6. In vivo and 3D visualization of coronary artery development by optical coherence tomography - art. no. 662709

    DEFF Research Database (Denmark)

    Thrane, Lars; Norozi, K.; Männer, J.

    2007-01-01

    . The in vivo images were generated by optical coherence tomography (OCT). The OCT system used in this study is a mobile fiber-based time-domain real-time OCT system operating with a center wavelength of 1330 nm, an A-scan rate of 4 kHz, and a typical frame rate of 8 frames/s. The axial resolution is 17 mu m......One of the most critical but poorly understood processes during cardiovascular development is the establishment of a functioning coronary artery (CA) system. Due to the lack of suitable imaging technologies, it is currently impossible to visualize this complex dynamic process on living human...... (in tissue), and the lateral resolution is 30 mu m. The OCT system is optimized for in vivo chick heart visualization and enables OCT movie recording with 8 frames/s, full-automatic 3D OCT scanning, and blood flow visualization, i.e., Doppler OCT imaging. Using this OCT system, we generated in vivo...

  7. Childhood abuse, parental warmth, and adult multisystem biological risk in the Coronary Artery Risk Development in Young Adults study.

    Science.gov (United States)

    Carroll, Judith E; Gruenewald, Tara L; Taylor, Shelley E; Janicki-Deverts, Denise; Matthews, Karen A; Seeman, Teresa E

    2013-10-15

    Childhood abuse increases adult risk for morbidity and mortality. Less clear is how this "toxic" stress becomes embedded to influence health decades later, and whether protective factors guard against these effects. Early biological embedding is hypothesized to occur through programming of the neural circuitry that influences physiological response patterns to subsequent stress, causing wear and tear across multiple regulatory systems. To examine this hypothesis, we related reports of childhood abuse to a comprehensive 18-biomarker measure of multisystem risk and also examined whether presence of a loving parental figure buffers against the impact of childhood abuse on adult risk. A total of 756 subjects (45.8% white, 42.7% male) participated in this ancillary substudy of the Coronary Artery Risk Development in Young Adults Study. Childhood stress was determined by using the Risky Families Questionnaire, a well-validated retrospective self-report scale. Linear regression models adjusting for age, sex, race, parental education, and oral contraceptive use found a significant positive relationship between reports of childhood abuse and multisystem health risks [B (SE) = 0.68 (0.16); P childhood was associated with lower multisystem health risks [B (SE) = -0.40 (0.14); P childhood had the highest multisystem risk in adulthood.

  8. An unreported type of coronary artery naomaly in congenitally corrected transposition of great arteries

    Energy Technology Data Exchange (ETDEWEB)

    Kwak, Min Kyu; Jeong, Yeon Joo; Lee, Gee Won; Lee, Nam Kyung; Choi, Jung Hyun; Lee, Ji Won [Medical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of)

    2016-07-15

    Coronary artery variations are associated anomalies in 45% of congenitally corrected transposition of the great arteries (ccTGA) cases, and it is important to detect any coronary artery anomalies before cardiac surgery. We report a case of a 51-year-old woman with ccTGA and an unreported type of coronary artery anomaly.

  9. Diagnosing coronary artery disease after a positive coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Nissen, L; Winther, S; Westra, J

    2018-01-01

    Aims: Perfusion scans after coronary computed tomography angiography (CCTA) in patients with suspected coronary artery disease (CAD) may reduce unnecessary invasive coronary angiographies (ICAs). However, the diagnostic accuracy of perfusion scans after primary CCTA is unknown. The aim...

  10. Childhood Antecedents to Adult Coronary Artery Diseases. Special Reference Briefs.

    Science.gov (United States)

    Winick, Myron

    This reference brief deals with the childhood antecedents to atherosclerosis and hypertension. While diet is related to the development of coronary artery diseases, there is some disagreement about what dietary changes are necessary or desirable in children to prevent their development, and at what age such changes should be made. Fifty-five…

  11. Genetically Determined Height and Coronary Artery Disease

    NARCIS (Netherlands)

    Nelson, Christopher P.; Hamby, Stephen E.; Saleheen, Danish; Hopewell, Jenna C.; Zeng, Lingyao; Assimes, Themistocles L.; Kanoni, Stavroula; Willenborg, Christina; Burgess, Stephen; Amouyel, Phillipe; Anand, Sonia; Blankenberg, Stefan; Boehm, Bernhard O.; Clarke, Robert J.; Collins, Rory; Dedoussis, George; Farrall, Martin; Franks, Paul W.; Groop, Leif; Hall, Alistair S.; Hamsten, Anders; Hengstenberg, Christian; Hovingh, G. Kees; Ingelsson, Erik; Kathiresan, Sekar; Kee, Frank; König, Inke R.; Kooner, Jaspal; Lehtimäki, Terho; März, Winifred; McPherson, Ruth; Metspalu, Andres; Nieminen, Markku S.; O'Donnell, Christopher J.; Palmer, Colin N. A.; Peters, Annette; Perola, Markus; Reilly, Muredach P.; Ripatti, Samuli; Roberts, Robert; Salomaa, Veikko; Shah, Svati H.; Schreiber, Stefan; Siegbahn, Agneta; Thorsteinsdottir, Unnur; Veronesi, Giovani; Wareham, Nicholas; Willer, Cristen J.; Zalloua, Pierre A.; Erdmann, Jeanette

    2015-01-01

    BACKGROUND The nature and underlying mechanisms of an inverse association between adult height and the risk of coronary artery disease (CAD) are unclear. METHODS We used a genetic approach to investigate the association between height and CAD, using 180 height-associated genetic variants. We tested

  12. Detecting asymptomatic coronary artery disease using routine ...

    African Journals Online (AJOL)

    ECG-monitored exercise testing has been proposed as a relatively inexpensive and effective means of screening for asymptomatic coronary artery disease in patients presenting for peripheral vascular surgery. Despite the fact that exercise thallium scintigraphy is also dependent on the patient's ability to exercise, using this ...

  13. Imaging diagnosis of congenital heart disease with single coronary artery

    International Nuclear Information System (INIS)

    Zhu Ming; Li Yuhua; Zhong Yumin; Sun Aimin

    2003-01-01

    Objective: To report 56 cases of congenital heart disease with congenital single coronary artery and to evaluate the imaging diagnostic techniques. Methods: All 56 patients with congenital single coronary artery underwent angiocardiography. Contrast enhancement magnetic resonance angiography (CE MRA) was performed in 4 cases. 48 cases were confirmed by operation. Results: In these 56 cases, single left coronary artery was found in 44 cases and single right coronary artery was found in 12. Conclusion: Congenital heart disease with congenital single coronary artery is not rare and correct diagnosis is very important for surgery

  14. Congenital coronary-pulmonary artery fistula originating from right and left coronary artery

    Directory of Open Access Journals (Sweden)

    Ali Kemal Gür

    2013-12-01

    Full Text Available Coronary artery fistula (CAF is a rare congenital anomalywith an incidence of 1 in 50 000 live births. The fistula wasobserved at the right coronary artery in 53%, the left coronaryartery in 42% and both coronary artery in 5% of thecases. Echocardiography examination in a 46 year-oldwoman with the symptoms of chest pain, palpitation anddyspnea revealed a severe mitral valve insufficiency anda moderate to severe tricuspid valve insufficiency. A CAForiginating from the proximal part of the left anterior descendingartery (LAD and another fistula originating fromosteal part of the right coronary artery (RCA were detectedby coronary angiography. Both fistulas were draininginto the main pulmonary artery. The coronary artery fistulaclosed under cardiopulmonary by-pass. Mitral insufficiencyoriginated from the posterior leaflet was diagnosedintra-operative exploration, and thereafter it was repairedwith mitral annuloplasty including a quadrangular resectionand use of a 32 No St Jude mitral ring. Tricuspid valvewas repaired with Calangos Ring annuloplasty. Followingsix day hospital stay, the woman was discharged free ofany symptom.Key words: Dyspnea, double arteriovenous fistula, mitral and tricuspid insufficiency

  15. Coronary artery anomalies in adults: imaging at dual source CT coronary angiography

    International Nuclear Information System (INIS)

    Laspas, Fotios; Roussakis, Arkadios; Mourmouris, Christos; Kritikos, Nikolaos; Efthimiadou, Roxani; Andreou, John

    2013-01-01

    Congenital abnormalities of the coronary arteries have an incidence of 1%, and most of these are benign. However, a small number are associated with myocardial ischaemia and sudden death. Various imaging modalities are available for coronary artery assessment. Recently, multi-detector CT has emerged as an accurate diagnostic tool for defining coronary artery anomalies. The purpose of this pictorial essay is to review the dual source CT appearance of congenital anomalies of the coronary arteries in adults.

  16. Single coronary artery from right aortic sinus in a very elderly patient

    Directory of Open Access Journals (Sweden)

    Prashanth Panduranga

    2016-10-01

    Full Text Available In the absence of other associated cardiac anomalies, single coronary artery (SCA per se is a rare anomaly detected during coronary angiography or autopsy. Various types of SCA detected during coronary angiography have already been described. We herein report a type of SCA originating from the right sinus of Valsalva, with the right circumflex, left circumflex, and left anterior descending coronary arteries arising from the proximal part of the SCA in a 76-year-old female patient. She developed ventricular fibrillation during coronary angiography, which calls for caution while performing a coronary angiogram in such patients.

  17. Patent Ductus Arteriosus Associated with Congenital Anomaly of Coronary Artery

    OpenAIRE

    Maleki, Majid; Azizian, Nassrin; Esmaeilzadeh, Maryam; Moradi, Bahieh

    2013-01-01

    We reported a case of patent ductus arteriosus (PDA) with congenital anomaly of coronary arteries as abnormal origin of right coronary artery (RCA) and left coronary artery (LCA) from a single ostium of the right coronary sinus. A 21-year-old man referred to our institution for evaluation of cardiac murmur. He has suffered from palpitation and atypical chest pain for three months. On physical examination, a continuous murmur was heard in the second left parasternal space. Transthoracic echoca...

  18. Coronary Artery Disease - Coronary Heart Disease

    Science.gov (United States)

    ... not as great as men's. Heredity (Including Race) Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe high blood pressure than Caucasians and a higher risk of heart ...

  19. Circulating tocopherols and risk of coronary artery disease: A systematic review and meta-analysis.

    Science.gov (United States)

    Li, Guangxiao; Li, Ying; Chen, Xin; Sun, Hao; Hou, Xiaowen; Shi, Jingpu

    2016-05-01

    Circulating level of tocopherols was supposed to be associated with risk of coronary artery disease. However, the results from previous studies remain controversial. Therefore, we conducted a meta-analysis based on observational studies to evaluate the association between circulating tocopherols and coronary artery disease risk for the first time. Meta-analysis. PubMed, Embase and Cochrane databases were searched to retrieve articles published during January 1995 and May 2015. Articles were included if they provided sufficient information to calculate the weighted mean difference and its corresponding 95% confidence interval. Circulating level of total tocopherols was significantly lower in coronary artery disease patients than that in controls (weighted mean difference -4.33 μmol/l, 95% confidence interval -6.74 to -1.91, P tocopherol alone was not significantly associated with coronary artery disease risk. Results from subgroup analyses showed that a lower level of circulating total tocopherols was merely associated with higher coronary artery disease risk in studies with higher sex ratio in cases (tocopherols was associated with early onset coronary artery disease rather than late onset coronary artery disease (tocopherols when the studies were stratified by matching status and assay methods. Our findings suggest that a deficiency in circulating total tocopherols might be associated with higher coronary artery disease risk. Whereas circulating α-tocopherol alone could not protect us from developing coronary artery disease. Further prospective studies were warranted to confirm our findings. © The European Society of Cardiology 2015.

  20. Moderators of Coronary Vasomotion during Mental Stress in Coronary Artery Disease Patients: Stress Reactivity, Serum Lipoproteins, and Severity of Atherosclerosis

    National Research Council Canada - National Science Library

    Howell, Robert H

    1996-01-01

    Impaired coronary artery vasomotion in response to behavioral triggers such as mental stress may be an important pathophysiological process involved in acute manifestations of coronary artery disease...

  1. Visualization of the coronary arteries. 6

    International Nuclear Information System (INIS)

    Koch, M.; Von Schulthess, G.K.

    1991-01-01

    Since MRI is very sensitive to motion, flow and perfusion, in addition to its ability to depict detailed morphology, it has many excellent advantages as a tool for studying vascular structures. These include its noninvasive nature, excellent and to a large degree user adjustable contrast between flowing blood and cardiovascular structures, and the ability to produce direct images in any plane. The coronary arteries can be identified in their proximal parts when imaging is done using sections perpendicular to the aortic root, more distally located portions are detected inconsistently and should not be confounded with cardiac veins. With gradient-echo imaging and MR angiograpic (MRA) methods the coronaries can be visualized well, because their is a positive, rather than a negative vascular contrast as found in spin-echo (SE) images. With regard to coronary artery imaging, to date MRA does not challenge the primary role of conventional coronary angiography. Conventional angiograms have superior spatial resolution and are less sensitive to degradation by flow disturbances. Current MRA is a purely experimental procedure and MRI of the coronary vessels is a research endeavour. (author). 32 refs.; 7 figs

  2. Anomalous right coronary artery arising from the pulmonary artery and constrictive pericarditis: an unusual association

    Science.gov (United States)

    Silvestre, Odilson Marcos; Adam, Eduardo Leal; de Melo, Dirceu Thiago Pessoa; Dias, Ricardo Ribeiro; Ramires, Felix J. A.; Mady, Charles

    2013-01-01

    ABSTRACT The association of anomalous right coronary artery originating from the pulmonary artery and constrictive pericarditis has never been showed in the literature. We present the first case of this unusual association in a patient with right heart failure. After diagnosis, the patient was referred to surgery and underwent phrenic-to-phrenic pericardiectomy; graft implant of right internal thoracic artery to right coronary artery; and ligation of the anomalous origin of the right coronary artery from the pulmonary artery. Such procedures solved the potential risk of sudden death related to anomalous right coronary artery originating from the pulmonary artery and alleviated the symptoms of heart failure caused by constrictive pericarditis. PMID:24136766

  3. Successful transcatheter closure of coronary artery fistula in a child with single coronary artery: a heavy load and a long road.

    Science.gov (United States)

    Phasalkar, Manjunath; Thakkar, Bhavesh; Poptani, Vishal

    2013-07-01

    Single coronary artery is an uncommon variation of the coronary circulation. After transposition of great arteries, coronary artery fistulas are the most common associated cardiac anomalies in these patients. Transcatheter closure of coronary artery fistula (CAF) involving single coronary artery is a challenging intervention. In the absence of contralateral coronary artery, a complex anatomy of the CAF and a large myocardial perfusion territory of the dominant circulation pose an additional risk during interventional procedure. We report our experience of a successful transcatheter closure of a coronary artery fistula in a patient with single coronary artery. Copyright © 2013 Wiley Periodicals, Inc.

  4. Various clinical scenarios leading to development of the string sign of the internal thoracic artery after coronary bypass surgery: the role of competitive flow, a case series

    Directory of Open Access Journals (Sweden)

    Kolozsvari Rudolf

    2012-01-01

    Full Text Available Abstract Background The left internal mammary artery (LIMA is the choice for grafting of the left anterior descending coronary artery (LAD. One possible mechanism of the rare graft failure involve the presence of competitive flow. Method 105 patients who had undergone coronary bypass grafting between 1998 and 2000 were included in this observational study. The recatheterizations were performed 28 months after the operations. The rate of patency the LIMA grafts was determined, and the cases with graft failure were analyzed. Results The LIMA graft was patent in 99 patients (94%. Six patients (6% exhibited diffuse involution of the graft (string sign. The string sign was always associated with competitive flow as the basis of the LIMA graft involution. In one case quantitative re-evaluation of the preoperative coronary angiography revealed merely less than 50% diameter stenosis on the LAD with a nonligated side-branch of the LIMA. At recatheterization in two patients the pressure wire measurements demonstrated only a non-significant decrease of the fractional flow reserve (0.83 and 0.89, despite the 53% and 57% diameter stenosis in the angiogram. Another patient displayeda significant regression of the LAD lesion between the pre- and postoperative coronary angiography (from 76% to 44% as the cause of the development of the competitive flow. In one instance, a radial artery graft on the LAD during a redo bypass operation resulted in competitive flow in the radial graft due to the greater diameter than that of the LIMA. In a further patient, competitive flow developed from a short sequential part of the LIMA graft between the nonsignificantly stenosed diagonal branch and the LAD, with involution of the main part of the graft to the diagonal branch. Conclusions The most common cause of the development of the string sign of a LIMA graft due to competitive flow is overassessment of the lesion of the LAD. Regression of a previous lesion or some other

  5. Determination of human coronary artery composition by Raman spectroscopy.

    Science.gov (United States)

    Brennan, J F; Römer, T J; Lees, R S; Tercyak, A M; Kramer, J R; Feld, M S

    1997-07-01

    We present a method for in situ chemical analysis of human coronary artery using near-infrared Raman spectroscopy. It is rapid and accurate and does not require tissue removal; small volumes, approximately 1 mm3, can be sampled. This methodology is likely to be useful as a tool for intravascular diagnosis of artery disease. Human coronary artery segments were obtained from nine explanted recipient hearts within 1 hour of heart transplantation. Minces from one or more segments were obtained through grinding in a mortar and pestle containing liquid nitrogen. Artery segments and minces were excited with 830 nm near-infrared light, and Raman spectra were collected with a specially designed spectrometer. A model was developed to analyze the spectra and quantify the amounts of cholesterol, cholesterol esters, triglycerides and phospholipids, and calcium salts present. The model provided excellent fits to spectra from the artery segments, indicating its applicability to intact tissue. In addition, the minces were assayed chemically for lipid and calcium salt content, and the results were compared. The relative weights obtained using the Raman technique agreed with those of the standard assays within a few percentage points. The chemical composition of coronary artery can be quantified accurately with Raman spectroscopy. This opens the possibility of using histochemical analysis to predict acute events such as plaque rupture, to follow the progression of disease, and to select appropriate therapeutic interventions.

  6. Early life stress and inflammatory mechanisms of fatigue in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

    Science.gov (United States)

    Cho, Hyong Jin; Bower, Julienne E; Kiefe, Catarina I; Seeman, Teresa E; Irwin, Michael R

    2012-08-01

    Fatigue is highly prevalent and causes serious disruption in quality of life. Although cross-sectional studies suggest childhood adversity is associated with adulthood fatigue, longitudinal evidence of this relationship and its specific biological mechanisms have not been established. This longitudinal study examined the association between early life stress and adulthood fatigue and tested whether this association was mediated by low-grade systemic inflammation as indexed by circulating C-reactive protein (CRP) and interleukin-6 (IL-6). In the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based longitudinal study conducted in 4 US cities, early life stress was retrospectively assessed in 2716 African-American and white adults using the Risky Families Questionnaire at Year 15 examination (2000-2001, ages 33-45 years). Fatigue as indexed by a loss of subjective vitality using the Vitality Subscale of the 12-item Short Form Health Survey was assessed at both Years 15 and 20. While CRP was measured at both Years 15 and 20, IL-6 was measured only at Year 20. Early life stress assessed at Year 15 was associated with adulthood fatigue at Year 20 after adjustment for sociodemographic characteristics, body-mass index, medication use, medical comorbidity, smoking, alcohol consumption, physical activity, current stress, pain, sleep disturbance as well as Year 15 fatigue (adjusted beta 0.047, P=0.007). However, neither CRP nor IL-6 was a significant mediator of this association. In summary, early life stress assessed in adulthood was associated with fatigue 5 years later, but this association was not mediated by low-grade systemic inflammation. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Coronary artery disease and symptoms of depression in a Kenyan ...

    African Journals Online (AJOL)

    Coronary artery disease and symptoms of depression in a Kenyan population. ... death. Little is known about the co-morbidity of heart disease and depression in Africa. Objective: To describe the prevalence of depression in Black Africans with and without. Coronary Artery Disease as documented on coronary angiography ...

  8. Circumflex coronary artery with aberrant origin and atherosclerosis

    International Nuclear Information System (INIS)

    Ozcan, E.; Bozlar, U.; Celik, T.; Tasar, M.

    2012-01-01

    Full text: Introduction: Circumflex (Cx) coronary artery congenital anomaly is reported to be less than 1% incidence. Coronary arteries with aberrant origin are more likely to have atherosclerosis according to some published literatures. Objectives and tasks: In this study we aim to present computed tomography (CT) angiography findings of a patient, who has Cx artery with aberrant origin and atherosclerotic. Materials and methods: 57-year-old woman without any symptoms who has risk factors to atherosclerosis was referred to our clinic for coronary CT angiography. Results: In CT angiography; we detected Cx coronary artery with aberrant origin (right sinus of valsalva) and retroaortic course. Also we saw intimal irregularities and calcified plaque causing severe narrowing in the proximal segment of artery. Right coronary and left anterior descendant arteries had mild atherosclerosis. Conclusion: Coroner CT angiography, which allows multiplanar imaging with high resolution, is an effective diagnostic tool for coronary artery disease, like not only congenital anomalies but also acquired atherosclerotic disease

  9. Prevalence and risk factors of premature coronary artery disease in patients undergoing coronary angiography in Kurdistan, Iraq.

    Science.gov (United States)

    Mohammad, Ameen Mosa; Jehangeer, Hekmat Izzat; Shaikhow, Sabri Khalif

    2015-11-18

    Premature coronary artery disease (PCAD) seems to increase, particularly in developing countries. Given the lack of such studies in the country, this study examines the prevalence, associated cardiovascular risk factors, and coronary angiographic profile of the disease in Iraq. Data was collected from a total of 445 adult patients undergoing coronary angiography at Duhok Heart Center, Kurdistan in a period between March and September 2014. Patients were divided into PCAD (male 70 % compared to lesser obstruction. Premature coronary artery disease is alarming  in the country. Cardiovascular risk factors are clustered among them. But the angiographic profile and therapeutic options of PCAD are close to those reported from previous studies.

  10. Non-invasive method for recognition of coronary artery spasm

    International Nuclear Information System (INIS)

    Mathey, D.; Montz, R.; Hanrath, P.; Kuck, K. H.; Bleifeld, W.; Hamburg Univ.

    1980-01-01

    For evaluation of coronary artery spasm 201 thallium sequential scintigraphy of the myocardium after ergotamine provocation was performed in 10 patients with recurrent angina pectoris at rest and normal exercise ECG. In 9 out of the 10 patients ergotamine administration in the same dosage was repeated during the coronary angiography. A reversible defect in the 201 thallium scintigram representative of regional myocardial ischaemia developed in 9 patients after ergotamine. Only in 4 out of the 9 patients angina pectoris and ST elevation were present at the same time. In all cases coronary spasm after ergotamine was demonstrable in the coronary angiogram; in the 4 patients with ergotamine-induced Prinzmetal angina pectoris it consisted of complete vascular occlusion, in the asymptomatic patients of incomplete vascular narrowing of a higher degree. In all cases the spasm could be relieved by ergotamine antidotes within a few minutes. (orig.) [de

  11. [Surgical angioplasty of the left main coronary artery].

    Science.gov (United States)

    Vranes, Mile; Velinović, Milos; Kocica, Mladen; Mikić, Aleksandar; Velimirović, Dusan; Djukić, Petar

    2010-01-01

    The conventional treatment for isolated stenosis of the left main coronary artery is bypass surgery (myocardial revascularization). However, the process of atherosclerosis is not arrested by myocardial revascularization and it will lead to the occlusion of the left main coronary artery. Revascularization will establish retrograde perfusion for 50-70% of the myocardium of the left ventricle. Direct surgical angioplasty of the left main coronary artery enables normal physiological perfusion of the whole myocardium and better myocardial function. The aim of our study is to point out a new surgical approach of treating left main coronary artery stenosis. Between October 2002 and October 2003, direct surgical angioplasty of the main left coronary artery was performed on three patients with isolated stenosis of the left main coronary artery using the anterior approach and the pericardium as a patch. The procedure was performed under total endotracheal anaesthesia and standard cardiopulmonary circulation, moderate hypothermia, anterograde St. Tomas cardioplegia and local cooling. Patients were followed clinically, echocardiographically and by load-tests. All three patients were without complications. In postoperative follow-up (54-68 months) neither angina pectoris nor electrocardiographically registered ischaemic changes were found. Load-tests performed every six months on all three patients were negative. Surgical angioplasty of isolated stenosis of the left main coronary artery is a preferred method for treating this type of coronary disease. Contraindications for this type of treatment are stenosis of the left main coronary artery with bifurcation and advanced calcification of the left main coronary artery.

  12. Diabetic retinopathy: A predictor of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Fawzia El Demerdash

    2012-06-01

    Conclusion: Diabetic retinopathy is a good predictor of coronary artery disease that exceeds the conventional risk factors. Diabetics with retinopathy would benefit from early coronary angiography and diabetic retinocoronary clinics are warranted.

  13. Right Coronary Artery Originated from the Left Anterior Descending Artery in a Patient with Congenital Pulmonary Valvular Stenosis

    Directory of Open Access Journals (Sweden)

    Yusuf Hoşoğlu

    2013-01-01

    Full Text Available The single coronary artery, anomalous origin of the right coronary artery from the left anterior descending artery, is a benign and very rare coronary artery anomaly. We firstly present a case with this type of single coronary artery and congenital pulmonary valvular stenosis with large poststenotic dilatation.

  14. Depression in Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Nasser Safaie

    2012-09-01

    Full Text Available Introduction: Depression is one of the Common psychological disorders. From the cognitive point of view, the unhealthy attitudes increase the severity of the depression. The aim of this study was to investigate depression and unhealthy attitudes in coronary patients hospitalized at Tabriz Shahid Madani Heart Center. Methods: One hundred twenty eight hospitalized patients having myocardial Infarctions were studied regarding unhealthy attitudes, severity of depression and demographic data. Results: The study showed a significant relation between unhealthy attitudes, BDI (Beck Depression Inventory and severe depression. Moreover, a significant relation existed between gender and depression (P=0.0001. In addition, the level of education increased the intensity of unhealthy attitudes (P=0.0001. Several researches in both outside and inside Iran support the idea. Conclusion: Based on present study and more other investigations, it can be suggested to provide the necessary elements and parameters such as antidepressant medication, psychologists, complementary treatment for coping with negative mood and its unwanted consequences.

  15. Congenital heart disease with high origin of coronary artery

    International Nuclear Information System (INIS)

    Zhu Ming; Li Yuhua; Zhong Yumin

    2002-01-01

    Objective: To report 6 cases of congenital heart disease with high origin of coronary artery and to evaluate the imaging method for diagnosis of congenital high origin of coronary artery. Methods: Six patients with congenital high origin of coronary artery underwent angiocardiography, echocardiography, and 2 patients also underwent magnetic resonance examination. All 6 cases were confirmed by operation. Results: All 6 cases were congenital high origin of right coronary artery. Angiocardiography made correct diagnosis in all 6 cases; MRI made the correct diagnosis in 1 of the 2 cases; echocardiography made 1 correct diagnosis. Conclusion: Correct diagnosis of congenital high origin of coronary artery was very important for patients with congenital heart disease. Angiocardiography was a very reliable imaging method and MRI can play an important role in preoperative diagnosis of congenital high origin of coronary artery

  16. Contrast Media Delivery in the Assessment of Anomalous Left Coronary Artery From the Pulmonary Artery.

    Science.gov (United States)

    Saade, Charbel; Al-Hamra, Salam; Al-Mohiy, Hussain; El-Merhi, Fadi

    2016-05-01

    A patient with a history of mitral valve prolapse and regurgitation that was corrected with a mitral ring repair 15 years earlier received a diagnosis of anomalous left coronary artery arising from the pulmonary artery and underwent repair. Coronary computed tomography angiography (CTA) was employed to image the patient before surgical intervention. Synchronizing contrast media administration to opacify the right coronary artery in the arterial phase and the left coronary artery in the venous phase required a test-bolus approach. Matching compromised cardiovascular dynamics with patient-specific contrast media administration protocols was improved considerably with the use of a test-bolus technique during electrocardiography-gated coronary CTA.

  17. Correlation between obstructive coronary artery disease and electron beam tomography coronary artery calcium scan

    International Nuclear Information System (INIS)

    Lee, Sang Hoon; Hong, Yong Kook; Park, Sung Il; Lee, Hyang Mee; Choe, Kyu Ok

    1998-01-01

    To determine the correlation between obstructive coronary artery disease and electron beam tomography coronary artery calcium(EBT CAC) scan and to measure the difference in calcium score according to symptoms. Materials and Methods : Fifty-six patients underwent EBT CAC scanning and either coronary angiography or stress thallium 201 scanning or the treadmill test. When the results were positive, coronary artery obstructive disease(CAOD) was assumed to be present. The patients were divided into three groups : symptomatic CAOD,asymptomatic CAOD, and asymptomatic non- CAOD; those with a previous history of myocardial ischemia or who showed positive results in any of the three tests relating to typical symptoms of angina were assigned to the symptomatic group. Results : The number of cases assigned to group to group 1,2 and 3 was 19, 16 and 21, respectively; total CAC scores were 571 ± 751, 600 ± 726 293± 401, respectively. The difference in CAC score between asymptomatic CAOD and asymptomatic non- CAOD was not statistically significant(p=0.079) but in asymptomatic CAOD, the score tended to be higher. The CAC score was not different between symptomatic and asymptomatic CAOD(p>0.1). When the CAC threshold was 1, sensitivity was 89% and specificity was 14%;when the threshold was 200, sensitivity was 60% and specificity was 67%. Conclusion : When the EBT CAC score is high, further evaluation provides early evidence of coronary artery obstructive disease

  18. Subacute narrowing of the left main coronary artery following directional atherectomy for proximal obstructive coronary artery disease

    NARCIS (Netherlands)

    Piek, J. J.; Koch, K. T.; van der Wal, A. C.; Becker, A. E.

    1997-01-01

    Directional atherectomy is an alternative device for treatment of highly eccentric or proximal coronary lesions considered less suitable for balloon angioplasty. We report a patient with exuberant neointimal proliferation, extending into the left main coronary artery, following directional

  19. Transesophageal echocardiography in the assessment of coronary arteries

    International Nuclear Information System (INIS)

    Adamek-Kosmider, A.; Kasprzak, J.; Kosmider, M.; Krzeminska-Pakula, M.

    1993-01-01

    The study was undertaken to assess the usefulness of TEE for evaluation of morphology and flow in coronary arteries. TEE (2D, spectral and color Doppler imaging) and coronary angiography were performed in 75 patients - 41 with valvular heart disease and 34 with ischemic heart disease. Proximal coronary artery stenosis was detected by coronarography in 11 pts (9-left main coronary artery, 2-right coronary artery). TEE visualization of proximal coronary arteries was possible in all pts. Echocardiographic features of artery stenosis were: the narrowing of the vessel in 2D image (9 pts), high flow velocity spectral Doppler (4 pts, mean 135 cm/s vs 55 cm/s in normal arteries) and mosaic, turbulent flow in color Doppler (10 pts). Sensitivity and specificity of TEE for coronary artery stenosis detection was respectively 81%/98% for 2D imaging and 90%/100% for color Doppler. TEE is a new, noninvasive and safe method for the evaluation of proximal coronary arteries. Detection of LMCA stenosis prior to atheterization may enhance the safety of coronary angiography. (author)

  20. Prediction of coronary artery bypass graft flow

    International Nuclear Information System (INIS)

    Tamiya, Eiji; Hada, Yoshiyuki; Asano, Ken-ichi; Iio, Masahiro.

    1991-01-01

    To predict the coronary artery bypass graft (CABG) flow based on the time density curve (TDC) obtained from the digital subtraction aortograms (DSA), we developed a pulsatile CABG model (perfusion pressure 60,130 mmHg, pulse rate 53,126/min, cardiac output 3-7 l/min, diameter of the graft 2.1∼6.0 mm). After positioning the regions of interest (ROI), we injected contrast medium(5∼40 ml/sec, 5∼40 ml) into the outlet conduit. Concerning the TDCs, we calculated appearance time (Ta), peak densities (Dp), peak time (Tp), disappearance time (Td), integral of TDC, ΔTp (difference of Tp between two ROI) and ΔTa (difference of Ta between two ROI). Perfusion pressure, graft flow and output curve were similar to those of patients with CABG. Ta, Tp, Td, and ΔTp were affected by both the injection rate and the volume of the contrast medium; while Dp and the TDC integral were only affected by the latter parameter. Under the same conditions of contrast medium injection, the TDC depended strongly on graft flow, diameter of the graft, output and pulse rate. 21.6+0.92π·d 2 /4·Δ1/ΔTp·60 provided the most accurate estimation of CABG flow (r=0.865, p<0.01). We conclude that densitometric analysis of DSA may be useful in the prediction of CABG flow. (author)

  1. Observed Influence of Nitroglycerine on Myocardial Perfusion Scintigraphy in Patients with Multiple Vessel Coronary Artery Disease and Well-Developed Collaterals

    International Nuclear Information System (INIS)

    Rasulova, Nigora; Nazirova, Lyudmila; Akhmedov, Khasan; Akhmedova, Dilyafruz; Djalalov, Farrukh; Seydaliev, Amet; Iskandarov, Farkhod; Kok, T. Y.

    2012-01-01

    The objective of this scientific work was to evaluate the extent and severity of perfusion abnormalities on myocardial perfusion scintigraphy (MPS) at rest and with sublingual nitroglycerine, in relation to the presence and anatomical location of collaterals demonstrated by selective coronary angiography (SCA). Twenty-eight patients with unstable angina underwent selective coronary angiography. Eighteen of them were diagnosed with myocardial infarction (MI) 2–15 days prior to examination. Presence or absence of collaterals was noted, with anatomical depiction of donor and recipient arteries as well as evaluation of degree of collateral flow. As an inclusion criterion, collateral flow had to be grade 2 (partial epicardial filling of the occluded artery) or 3 (complete epicardial filling of the occluded artery) in accordance with the Rentrop collateral flow classification. Flow was noted as follows: Complete antegrade (CA), complete retrograde (CR), partial antegrade (PA), and partial retrograde (PR). Myocardial perfusion scintigraphy using Tc-99m Sestamibi at rest and after sublingual administration of nitroglycerine was performed according to a 2-day protocol. Perfusion abnormalities, which were quantified using the 20-segments model and visual 5-point system (0, normal perfusion; 4, absent perfusion), were analyzed according to donor's and recipient's territories, as well as territories with limited or without collateral flow (PA/PR, grade 0–1 flow). A total of 84 arteries were analyzed, with stenosis in 79 of them. Arteries were divided into three groups: Donors (group I), recipients (group II), and arteries with limited or without collaterals (group III). In group I, there were 28 donor arteries, with mean severity of stenosis 71.3 ± 0.65%. In group II, there were 36 recipient arteries and mean severity of stenosis was 94.8 ± 0.26%. In group III, there were 20 arteries, and all of them had either no or poorly developed collaterals (mean severity

  2. Reverse 201Tl myocardial redistribution induced by coronary artery spasm

    International Nuclear Information System (INIS)

    Xiang Dingcheng; Yin Jilin; Gong Zhihua; Xie Zhenhong; Zhang Jinhe; Wen Yanfei; Yi Shaodong

    2010-01-01

    Objective: To investigate the mechanism of reverse redistribution (RR) on dipyridamole 201 Tl myocardial perfusion studies in the patients with coronary artery spasm. Methods: Twenty-six patients with coronary artery spasm and presented as RR on dipyridamole 201 Tl myocardial perfusion studies were enlisted as RR group, while other 16 patients with no coronary artery stenosis nor RR were enlisted as control group. Dipyridamole test was repeated during coronary angiography. Corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) were measured at RR related and non-RR related coronary arteries before and after dipyridamole infusion respectively. All of the data were analyzed by Student's t-test or χ 2 -test and correlation analysis. Results: Coronary artery angiography showed slower blood flow and lower myocardial perfusion in RR related vessels when compared with non-RR related vessels in RR group, but there was no significant difference among the main coronary arteries in control group. The perfusion defects of RR area at rest were positively related to slower blood velocity at corresponding coronary arteries (r = 0.79, t =10.18, P 0.05). Conclusion: RR is related to the decreased blood flow and myocardial perfusion induced by coronary artery spasm at rest, which may be improved by stress test such as intravenous dipyridamole infusion. (authors)

  3. Single coronary artery; extremely rare coronary anomaly successfully treated surgically in young adult male.

    LENUS (Irish Health Repository)

    Shah, A R

    2010-05-01

    Single coronary artery arising from aortic root, is a rare congenital anomaly. A 30-year-old male presented with acute myocardial infarction (MI) complaining of chest pain and raised troponin levels. Emergency angiography showed no coronary lesions but both left and right coronary arteries arising from single ostium. Patient was operated electively and perioperative findings confirmed the diagnosis of single coronary artery, as left coronary artery after taking origin from right sinus of valsalva runs through the septum, before dividing into left anterior descending and circumflex branches. The single coronary ostium opened with a slit like incision over the course of left main coronary, making the size of ostium three to four times bigger than the native one. In addition left internal mammary artery was harvested and grafted to the left anterior descending branch distally. Patient made successful recovery. Four months follow up dobutamine stress echo showed no inducible ischemia.

  4. Frequency and clinical predictors of coronary artery disease in chronic renal failure renal transplant candidates.

    Science.gov (United States)

    de Albuquerque Seixas, Emerson; Carmello, Beatriz Leone; Kojima, Christiane Akemi; Contti, Mariana Moraes; Modeli de Andrade, Luiz Gustavo; Maiello, José Roberto; Almeida, Fernando Antonio; Martin, Luis Cuadrado

    2015-05-01

    Cardiovascular diseases are major causes of mortality in chronic renal failure patients before and after renal transplantation. Among them, coronary disease presents a particular risk; however, risk predictors have been used to diagnose coronary heart disease. This study evaluated the frequency and importance of clinical predictors of coronary artery disease in chronic renal failure patients undergoing dialysis who were renal transplant candidates, and assessed a previously developed scoring system. Coronary angiographies conducted between March 2008 and April 2013 from 99 candidates for renal transplantation from two transplant centers in São Paulo state were analyzed for associations between significant coronary artery diseases (≥70% stenosis in one or more epicardial coronary arteries or ≥50% in the left main coronary artery) and clinical parameters. Univariate logistic regression analysis identified diabetes, angina, and/or previous infarction, clinical peripheral arterial disease and dyslipidemia as predictors of coronary artery disease. Multiple logistic regression analysis identified only diabetes and angina and/or previous infarction as independent predictors. The results corroborate previous studies demonstrating the importance of these factors when selecting patients for coronary angiography in clinical pretransplant evaluation.

  5. Bioresorbable scaffolds in the treatment of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2013-03-01

    Full Text Available Yaojun Zhang,1,2 Christos V Bourantas,1 Vasim Farooq,1 Takashi Muramatsu,1 Roberto Diletti,1 Yoshinobu Onuma,1 Hector M Garcia-Garcia,1 Patrick W Serruys11Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; 2Division of Cardiovascular Diseases, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of ChinaAbstract: Drug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has inherited pitfalls, namely the presence of a foreign body within the artery causing vascular inflammation, late complications such as restenosis and stent thrombosis, and impeding the restoration of the physiologic function of the stented segment. Bioresorbable scaffolds (BRS were introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Currently, several BRSs are available, undergoing evaluation either in clinical trials or in preclinical settings. The aim of this review is to present the new developments in BRS technology, describe the mechanisms involved in the resorption process, and discuss the potential future prospects of this innovative therapy.Keywords: bioresorbable scaffold, drug-eluting stent, biodegradable, design, mechanism, coronary artery disease

  6. A quality score for coronary artery tree extraction results

    Science.gov (United States)

    Cao, Qing; Broersen, Alexander; Kitslaar, Pieter H.; Lelieveldt, Boudewijn P. F.; Dijkstra, Jouke

    2018-02-01

    Coronary artery trees (CATs) are often extracted to aid the fully automatic analysis of coronary artery disease on coronary computed tomography angiography (CCTA) images. Automatically extracted CATs often miss some arteries or include wrong extractions which require manual corrections before performing successive steps. For analyzing a large number of datasets, a manual quality check of the extraction results is time-consuming. This paper presents a method to automatically calculate quality scores for extracted CATs in terms of clinical significance of the extracted arteries and the completeness of the extracted CAT. Both right dominant (RD) and left dominant (LD) anatomical statistical models are generated and exploited in developing the quality score. To automatically determine which model should be used, a dominance type detection method is also designed. Experiments are performed on the automatically extracted and manually refined CATs from 42 datasets to evaluate the proposed quality score. In 39 (92.9%) cases, the proposed method is able to measure the quality of the manually refined CATs with higher scores than the automatically extracted CATs. In a 100-point scale system, the average scores for automatically and manually refined CATs are 82.0 (+/-15.8) and 88.9 (+/-5.4) respectively. The proposed quality score will assist the automatic processing of the CAT extractions for large cohorts which contain both RD and LD cases. To the best of our knowledge, this is the first time that a general quality score for an extracted CAT is presented.

  7. DECT evaluation of noncalcified coronary artery plaque

    Energy Technology Data Exchange (ETDEWEB)

    Ravanfar Haghighi, Rezvan [Medical Imaging Research Center and Colorectal Research Center, Shiraz University of Medical Science, Shiraz 719 363 5899 (Iran, Islamic Republic of); Chatterjee, S. [BGVS Chemical Engineering Building (Old), Indian Institute of Science, Bangalore 560012 (India); Tabin, Milo; Singh, Rishi P.; Sharma, Munish; Krishna, Karthik [Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi 110029 (India); Sharma, Sanjiv; Jagia, Priya [Department of Cardiac-Radiology, All India Institute of Medical Sciences, New Delhi 110029 (India); Ray, Ruma; Arava, Sudhir [Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029 (India); Yadav, Rakesh [Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029 (India); Vani, V. C. [Department of Instrumentation and Applied Physics, Indian Institute of Science, Bangalore 560012 (India); Lakshmi, R.; Kumar, Pratik, E-mail: drpratikkumar@gmail.com [Department of Cardiac-Biochemistry, All India Institute of Medical Sciences, New Delhi 110029 (India); Mandal, Susama R. [Department of Medical Physics Unit IRCH, All India Institute of Medical Sciences, New Delhi 110029 (India)

    2015-10-15

    Purpose: Composition of the coronary artery plaque is known to have critical role in heart attack. While calcified plaque can easily be diagnosed by conventional CT, it fails to distinguish between fibrous and lipid rich plaques. In the present paper, the authors discuss the experimental techniques and obtain a numerical algorithm by which the electron density (ρ{sub e}) and the effective atomic number (Z{sub eff}) can be obtained from the dual energy computed tomography (DECT) data. The idea is to use this inversion method to characterize and distinguish between the lipid and fibrous coronary artery plaques. Methods: For the purpose of calibration of the CT machine, the authors prepare aqueous samples whose calculated values of (ρ{sub e}, Z{sub eff}) lie in the range of (2.65 × 10{sup 23} ≤ ρ{sub e} ≤ 3.64 × 10{sup 23}/cm{sup 3}) and (6.80 ≤ Z{sub eff} ≤ 8.90). The authors fill the phantom with these known samples and experimentally determine HU(V{sub 1}) and HU(V{sub 2}), with V{sub 1},V{sub 2} = 100 and 140 kVp, for the same pixels and thus determine the coefficients of inversion that allow us to determine (ρ{sub e}, Z{sub eff}) from the DECT data. The HU(100) and HU(140) for the coronary artery plaque are obtained by filling the channel of the coronary artery with a viscous solution of methyl cellulose in water, containing 2% contrast. These (ρ{sub e}, Z{sub eff}) values of the coronary artery plaque are used for their characterization on the basis of theoretical models of atomic compositions of the plaque materials. These results are compared with histopathological report. Results: The authors find that the calibration gives ρ{sub e} with an accuracy of ±3.5% while Z{sub eff} is found within ±1% of the actual value, the confidence being 95%. The HU(100) and HU(140) are found to be considerably different for the same plaque at the same position and there is a linear trend between these two HU values. It is noted that pure lipid type plaques

  8. Anomalous origin of the left coronary artery from the pulmonary artery in children: diagnostic use of multidetector computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Shen, Quanli; Yao, Qiong; Hu, Xihong [Children' s Hospital of Fudan University, Department of Radiology, Shanghai (China)

    2016-09-15

    Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly. It is important to demonstrate the anomalous origin of the left coronary artery and its course before surgery. To explore the clinical diagnostic use of multidetector CT coronary angiography in detecting anomalous origin of the left coronary artery from the pulmonary artery in children. Nine children (2 boys, 7 girls) ages 2 months to 9 years with surgically confirmed anomalous origin of the left coronary artery from the pulmonary artery were studied. Clinical data, transthoracic echocardiography and CT coronary angiography images were retrospectively analyzed. Transthoracic echocardiography correctly diagnosed anomalous origin of the left coronary artery from the pulmonary artery in 7 of 9 patients (95% CI: 40-97%). CT coronary angiography revealed the anomalous origin of the left coronary artery in all children (95% CI: 66-100%). In a 4-year-old girl and a 9-year-old girl, CT coronary angiography showed dilation of the right coronary artery and collateral circulation between the right and the left coronary arteries. CT coronary angiography is a useful method to show the anomalous origin of the coronary artery in children with anomalous origin of the left coronary artery from the pulmonary artery, especially for patients in whom origin of the left coronary artery cannot be detected by transthoracic echocardiography. (orig.)

  9. Anomalous origin of the left coronary artery from the pulmonary artery in children: diagnostic use of multidetector computed tomography

    International Nuclear Information System (INIS)

    Shen, Quanli; Yao, Qiong; Hu, Xihong

    2016-01-01

    Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly. It is important to demonstrate the anomalous origin of the left coronary artery and its course before surgery. To explore the clinical diagnostic use of multidetector CT coronary angiography in detecting anomalous origin of the left coronary artery from the pulmonary artery in children. Nine children (2 boys, 7 girls) ages 2 months to 9 years with surgically confirmed anomalous origin of the left coronary artery from the pulmonary artery were studied. Clinical data, transthoracic echocardiography and CT coronary angiography images were retrospectively analyzed. Transthoracic echocardiography correctly diagnosed anomalous origin of the left coronary artery from the pulmonary artery in 7 of 9 patients (95% CI: 40-97%). CT coronary angiography revealed the anomalous origin of the left coronary artery in all children (95% CI: 66-100%). In a 4-year-old girl and a 9-year-old girl, CT coronary angiography showed dilation of the right coronary artery and collateral circulation between the right and the left coronary arteries. CT coronary angiography is a useful method to show the anomalous origin of the coronary artery in children with anomalous origin of the left coronary artery from the pulmonary artery, especially for patients in whom origin of the left coronary artery cannot be detected by transthoracic echocardiography. (orig.)

  10. Total Arterial Off‑pump Coronary Revascularization with a Bilateral ...

    African Journals Online (AJOL)

    Total Arterial Off‑pump Coronary Revascularization with a Bilateral Internal Mammary Artery Y Graft (208 cases). Jun-Feng Yang, Hong-Chao Zhang1, Cheng-Xiong Gu, Hua Wei. INTRODUCTION. AY graft is a graft formed by the left internal mammary artery (LIMA) connected to the left anterior descending (LAD) artery and ...

  11. Intraoperative echocardiographic imaging of coronary arteries and graft anastomoses during coronary artery bypass grafting without cardiopulmonary bypass.

    Science.gov (United States)

    Suematsu, Y; Takamoto, S; Ohtsuka, T

    2001-12-01

    No accepted approach exists for the intraoperative evaluation of the quality of coronary arteries and the technical adequacy of graft anastomoses during coronary artery bypass grafting without cardiopulmonary bypass. We assessed the accuracy of high-frequency epicardial echocardiography and power Doppler imaging in evaluating coronary arteries during coronary artery bypass grafting without cardiopulmonary bypass. To validate measurements of coronary arteries and graft anastomoses by high-frequency epicardial echocardiography and power Doppler imaging, we compared luminal diameters determined by these methods with diameters determined histologically in a study of off-pump coronary artery bypass grafting in 20 dogs. Technical errors were deliberately created in 10 grafts (stenosis group). The results of these animal validation studies showed that the maximum luminal diameters of coronary arteries and graft anastomoses measured by high-frequency epicardial echocardiography (HEE) and power Doppler imaging (PDI) correlated well with the histologic measurements: HEE = 1.027 x Histologic measurements + 0.005 (P anastomoses were examined intraoperatively by high-frequency epicardial echocardiography and power Doppler imaging, and luminal diameters determined by power Doppler imaging were compared with those determined by postoperative coronary angiography. The results demonstrated that graft anastomosis by power Doppler imaging correlated well with the angiographic measurements: PDI = 1.018 x Angiographic measurements - 0.106 (P anastomoses and can detect technical errors and inadequacies during coronary artery bypass grafting without cardiopulmonary bypass.

  12. Coronary artery narrowing after aortic root reconstruction with resorcin-formalin glue.

    Science.gov (United States)

    Martinelli, L; Graffigna, A; Guarnerio, M; Bonmassari, R; Disertori, M

    2000-11-01

    Severe stenosis of right and left main coronary artery ostia developed after aortic root reconstruction with gelatin-resorcin-formol glue for correction of acute type A aortic dissection. Surgical treatment of this condition required grafting of the right and left anterior descending arteries with bilateral mammary arteries on the beating heart.

  13. Fractional Flow Reserve Assessment of a Coronary Artery Fistula

    Directory of Open Access Journals (Sweden)

    Joseph Petit

    2015-01-01

    Full Text Available A 63 y/o male with a past medical history of hypertension, chronic obstructive pulmonary disease, and obesity was admitted to an outside hospital for an abdominal incisional hernia repair and cholecystectomy. Post-operatively he developed shortness of breath (SOB and multiple runs of paroxysmal atrial fibrillation. A CT scan was negative for pulmonary embolism, but showed a left anterior descending (LAD coronary artery to main pulmonary artery (MPA fistula. He was transferred to our facility for further management.

  14. Left main coronary artery disease: pathophysiology, diagnosis, and treatment.

    Science.gov (United States)

    Collet, Carlos; Capodanno, Davide; Onuma, Yoshinobu; Banning, Adrian; Stone, Gregg W; Taggart, David P; Sabik, Joseph; Serruys, Patrick W

    2018-06-01

    The advent of coronary angiography in the 1960s allowed for the risk stratification of patients with stable angina. Patients with unprotected left main coronary artery disease have an increased risk of death related to the large amount of myocardium supplied by this vessel. Although coronary angiography remains the preferred imaging modality for the evaluation of left main coronary artery stenosis, this technique has important limitations. Angiograms of the left main coronary artery segment can be difficult to interpret, and almost one-third of patients can be misclassified when fractional flow reserve is used as the reference. In patients with clinically significant unprotected left main coronary artery disease, surgical revascularization was shown to improve survival compared with medical therapy and has been regarded as the treatment of choice for unprotected left main coronary artery disease. Two large-scale clinical trials published in 2016 support the usefulness of catheter-based revascularization in selected patients with unprotected left main coronary artery disease. In this Review, we describe the pathophysiology of unprotected left main coronary artery disease, discuss diagnostic approaches in light of new noninvasive and invasive imaging techniques, and detail risk stratification models to aid the Heart Team in the decision-making process for determining the best revascularization strategy for these patients.

  15. Neighborhood availability of convenience stores and diet quality: findings from 20 years of follow-up in the coronary artery risk development in young adults study.

    Science.gov (United States)

    Rummo, Pasquale E; Meyer, Katie A; Boone-Heinonen, Janne; Jacobs, David R; Kiefe, Catarina I; Lewis, Cora E; Steffen, Lyn M; Gordon-Larsen, Penny

    2015-05-01

    We examined the association between neighborhood convenience stores and diet outcomes for 20 years of the Coronary Artery Risk Development in Young Adults study. We used dietary data from the Coronary Artery Risk Development in Young Adults study years 1985-1986, 1992-1993, and 2005-2006 (n = 3299; Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA) and geographically and temporally matched neighborhood-level food resource and US Census data. We used random effects repeated measures regression to estimate associations between availability of neighborhood convenience stores with diet outcomes and whether these associations differed by individual-level income. In multivariable-adjusted analyses, greater availability of neighborhood convenience stores was associated with lower diet quality (mean score = 66.3; SD = 13.0) for participants with lower individual-level income (b = -2.40; 95% CI = -3.30, -1.51); associations at higher individual-level income were weaker. We observed similar associations with whole grain consumption across time but no statistically significant associations with consumption of sugar-sweetened beverages, artificially sweetened beverages, snacks, processed meats, fruits, or vegetables. The presence of neighborhood convenience stores may be associated with lower quality diets. Low-income individuals may be most sensitive to convenience store availability.

  16. Coronary artery disease - strategies for primary prevention in Pakistan

    International Nuclear Information System (INIS)

    Khan, M.H.

    2000-01-01

    Coronary artery disease is the leading cause of death among middle aged and elderly population. The increase in prevalence of coronary artery disease in Pakistan, has also involved the younger population and about 30% of the patients of coronary artery disease are below the age of 40 years. It seems that with this high prevalence of coronary artery disease, we will be entering in the new millennium with coronary artery disease as number one killer in young adults in Pakistan. This is the time, though belated, we must embark on strategies for primary prevention of this disease so that we are able to reduce the incidence of the disease and the economic burden it entails on the national exchequer. Before suggesting the strategies for the prevention of coronary artery disease in Pakistan, let us briefly review the significance of modifiable risk factors for coronary artery disease. Several studies have been found a significant relationship between physical inactivity and coronary artery disease. (A.B./orig.)

  17. Coronary artery calcium in breast cancer survivors after radiation therapy

    NARCIS (Netherlands)

    Takx, Richard A P; Vliegenthart, Rozemarijn; Schoepf, U Joseph; Pilz, Lothar R; Schoenberg, Stefan O; Morris, Pamela B; Henzler, Thomas; Apfaltrer, Paul

    The purpose of the current study is to investigate whether breast cancer survivors after radiation therapy have a higher burden of coronary artery calcium as a potential surrogate of radiation-induced accelerated coronary artery disease. 333 patients were included. 54 patients underwent chest CT ae

  18. Giant aneurysm in a left coronary artery fistula

    DEFF Research Database (Denmark)

    Frestad, Daria; Helqvist, Steffen; Helvind, Morten

    2013-01-01

    Congenital coronary artery fistula complicated with giant coronary artery aneurysm is a very rare condition. In this case report, we present a 65-year-old woman, referred to us with a continuous heart murmur, occasional atypical chest pain and few episodes of fainting. A giant aneurysm...

  19. Patent ductus arteriosus associated with congenital anomaly of coronary artery.

    Science.gov (United States)

    Maleki, Majid; Azizian, Nassrin; Esmaeilzadeh, Maryam; Moradi, Bahieh

    2013-11-01

    We reported a case of patent ductus arteriosus (PDA) with congenital anomaly of coronary arteries as abnormal origin of right coronary artery (RCA) and left coronary artery (LCA) from a single ostium of the right coronary sinus. A 21-year-old man referred to our institution for evaluation of cardiac murmur. He has suffered from palpitation and atypical chest pain for three months. On physical examination, a continuous murmur was heard in the second left parasternal space. Transthoracic echocardiography showed normal left and right ventricular size and systolic function (LVEF = 55%). Main pulmonary artery (PA) and left pulmonary artery (LPA) branch were considerably dilated. Considering normal coronary flow, lack of clinical evidence of myocardial ischemia and echocardiography findings, patient underwent surgical closure of PDA via left thoracotomy and after five days discharged uneventfully.

  20. Technical Considerations of Giant Right Coronary Artery Aneurysm Exclusion

    Directory of Open Access Journals (Sweden)

    James Barr

    2016-01-01

    Full Text Available Giant coronary artery aneurysms are rare clinical entities. We report the case of a 49-year-old man who presented with dyspnoea and exertional chest pain. Investigations confirmed an aneurysmal right coronary artery measuring 4 cm with a fistulous communication to the right atrium. Following right atriotomy, the fistula was oversewn and the aneurysmal right coronary artery ligated at its origin and at several points along its course. A saphenous vein graft was anastomosed to the posterior descending artery. Persistent ventricular fibrillation occurred upon chest closure, attributed to ischaemia following ligation of the aneurysmal coronary artery. Emergent resternotomy and internal defibrillation were successfully performed. The sternum was stented open to reduce right ventricular strain and closed the following day. The patient made an unremarkable recovery. We here address the technical challenges associated with surgical repair of right coronary aneurysms and the physiology and management of potential complications.

  1. The minimum coronary artery diameter in which coronary spasm can be identified by synchrotron radiation coronary angiography

    International Nuclear Information System (INIS)

    Matsushita, Shonosuke; Hyodo, Kazuyuki; Imazuru, Tomohiro; Tokunaga, Chiho; Sato, Fujio; Enomoto, Yoshiharu; Hiramatsu, Yuji; Sakakibara, Yuzuru

    2008-01-01

    Background: Coronary vasospasm is defined as a temporary, intense narrowing of the coronary conduit artery. It brings about ischemic chest pain and becomes one of the causes of myocardial infarction. Coronary spasms are divided into two categories. One is the coronary spasm of the conduit artery and the other is the coronary microvascular spasm. Although coronary spasms are diagnosed with the images of coronary angiography, microvascular spasms cannot be diagnosed because of the limitations of conventional angiographic systems. However, synchrotron radiation coronary angiography (SRCA) can identify coronary arteries down to 100 μm in diameter in the beating heart and 50 μm in arrested heart. Aim: The purpose of this study was to confirm whether microvascular spasms could be identified or not using SRCA, and then down that size identification was possible. Methods: The Langendorff perfusion system with isolated rat hearts was employed. Krebs-Henseleit solution (KH solution) was used as a perfusate. 10 mM of 4-aminopyridine (4-AP: a voltage-gated potassium channel blocker; spasm inducer) was added to the KH solution and maintained for 5 min. SRCA was performed at pre-, during and 10 min after cessation of the KH solution with 4-AP. Coronary spasms were defined as a temporal 75% reduction of coronary arterial diameter. Results and conclusion: Multiple sizes of coronary arteries showed coronary spasms. The minimum stenosed coronary artery size was 100 μm. Since coronary microvascular spasms are seen in the arterioles (50-400 μm), coronary microvascular spasms may be diagnosed with the use of synchrotron radiation coronary angiography

  2. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE)

    DEFF Research Database (Denmark)

    Mäkikallio, Timo; Holm, Niels R; Lindsay, Mitchell

    2016-01-01

    Background Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main...... coronary artery disease. Methods In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1: 1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable......, and 5% versus 2% (2 . 25, 0 . 93-5 . 48, p= 0 . 073) for stroke. Interpretation The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease....

  3. Left coronary arterial blood flow: Noninvasive detection by Doppler US

    International Nuclear Information System (INIS)

    Gramiak, R.; Holen, J.; Moss, A.J.; Gutierrez, O.H.; Picone, A.L.; Roe, S.A.

    1986-01-01

    Continuous wave (CW) and pulsed Doppler ultrasound studies with spectral analysis were used to detect the left coronary arterial blood flow in patients who were undergoing routine echocardiography. The pulmonary artery is a stable ultrasonic landmark from which detection of the blood flow can be effected. The left coronary artery can be distinguished by its blood flow toward the cardiac apex and by specific, functional flow features. Flow patterns vary among the left main, circumflex, and anterior descending arteries; patterns also vary with respiration cycles. In the present study, coronary arterial blood flow was detected in 58 of 70 patients (83%). Findings were validated by selectively injecting an agitated saline contrast medium into the left coronary artery and, in another study, by comparing human Doppler phasic flow waveforms with electromagnetic flowmeter recordings obtained in dogs

  4. Depressive symptoms in patients with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Débora Maria Mendonça da Cunha

    Full Text Available Objective.To assess the presence of depressive symptoms in patients with coronary artery disease in the preoperative period for coronary artery bypass surgery (CABG in Aracaju, Sergipe, Brazil. Methods. A cross-sectional study with 63 hospitalized patients prior to CABG. Two instruments were used for data collection; one for the sociodemographic and clinical characteristics, and the other to evaluate the presence of depressive symptoms, Beck Depression Inventory (BDI. Results. The mean age was 58 years; most were male (60.3%; with a partner (81% low educational level (71.4% attended school through elementary school. Among the patients, 36.5% were classified with dysphoria, and 25.4% had some degree of depression (6.3% mild, 17.5% moderate, and 1.6% severe. The group of patients with lower educational level presented higher depressive symptoms. Conclusion. Six of every ten patients with coronary artery disease showed dysphoria or some degree of depression. The results of this study can support the planning of nursing care for patients before and after CABG, as well as the development of public health policies to ensure complete, quality care for these patients, understanding depression as a variable that can interfere with recovery after cardiac surgery.

  5. Coexistence of Single Coronary Artery Anomaly and Aortic Arch Anomaly

    Directory of Open Access Journals (Sweden)

    Yilmaz Omur Otlu

    2014-03-01

    Full Text Available A 74-year-old male patient was admitted to our hospital for evaluation of recent onset atypical chest pain. His medical history included hypertension, dislipidemia and smoking. Physical examination was unremarkable. The resting electrocardiogram was demonstrated biphasic T waves on lateral derivations. Transthoracic echocardiography showed normal left and right ventricular dimensions and functions. Coronary angiography was planned for the patient. First, right transradial approach tried; but guidewire could not be advanced to ascendig aorta. Coronary angiography was performed through the right femoral artery. Multiple attempts to cannulate the left coronary ostium were unsuccessful. The right coronary artery cannulated from its normal ostium in the right sinus of Valsalva. After a very short common main stem, the artery divided into a right coronary artery, and separate left anterior descending artery and circumflex artery (Figure A. The coronary arteries were normal without any significant stenosis and any extrinsic compression. An aortic root injection confirmed the absence of left coronary ostium. Also, a retroesophageal right subclavian artery originating from the left aortic arch (arteria lusoria was detected as the last branch of aortic arch on contrast enhanced computerized tomography (Figure B-C. The patient discharged with medical teraphy.

  6. 78. Environmental air pollution: A new emerging factor for coronary artery disease

    Directory of Open Access Journals (Sweden)

    S.A. Meo

    2016-07-01

    Conclusion: Environmental pollution exert detrimental effects on the heart. The researchers and physicians must consider the environmental pollution as an emerging factor in the development of coronary artery disease.

  7. Defining Anatomic Variants of the Coronary Artery in Taiwanese Subjects Using 64-Multidetector-Row Computed Tomography

    Directory of Open Access Journals (Sweden)

    Hung-Jung Wang

    2007-10-01

    Full Text Available The newly developed 64-multidetector-row computed tomography (MDCT prompted us to evaluate coronary angiography using this noninvasive method. We reviewed 281 images of MDCT coronary angiography in Taiwanese. The origins of the coronary arteries were identified from the luminal aspect of the aorta. We described them as seen from the aortic sinus looking toward the cardiac ventricle. The sinus facing the left ventricle was designated sinus 1, and that facing the right ventricle was designated sinus 2. Anatomic variants of the coronary artery were divided into five types according to the structure of the left anterior descending artery, right coronary artery, and left circumflex artery. Of the 281 patients, 275 (97.9% had the type I variant in which the right coronary artery originated from sinus 2. MDCT provides advantages in defining anatomic variation and helps in the planning of clinical therapy or surgery.

  8. Morphometry of the coronary ostia and the structure of coronary arteries in the shorthair domestic cat

    Science.gov (United States)

    Barszcz, Karolina; Kupczyńska, Marta; Klećkowska-Nawrot, Joanna; Janeczek, Maciej; Goździewska-Harłajczuk, Karolina; Dzierzęcka, Małgorzata; Janczyk, Paweł

    2017-01-01

    The aim of this study was to measure the area of the coronary ostia, assess their localization in the coronary sinuses and to determine the morphology of the stem of the left and right coronary arteries in the domestic shorthair cat. The study was conducted on 100 hearts of domestic shorthair cats of both sexes, aged 2–18 years, with an average body weight of 4.05 kg. A morphometric analysis of the coronary ostia was carried out on 52 hearts. The remaining 48 hearts were injected with a casting material in order to carry out a morphological assessment of the left and right coronary arteries. In all the studied animals, the surface of the left coronary artery ostium was larger than the surface of the right coronary artery ostium. There were four types of the left main coronary artery: type I (23 animals, 49%)–double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch, which in turn gave off the septal branch), type II (12 animals, 26%)–double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch without the septal branch), type III (11 animals, 23%)–triple-branched left main stem (giving off the left circumflex branch, interventricular branch and the septal branch, type IV (1 animal, 2%)–double-branched left main stem (giving off the interventricular paraconal branch and the left circumflex branch, which in turn gave off the septal branch). The left coronary artery ostium is greater than the right one. There is considerable diversity in the branches of proximal segment of the left coronary artery, while the right coronary artery is more conservative. These results can be useful in defining the optimal strategies in the endovascular procedures involving the coronary arteries or the aortic valve in the domestic shorthair cat. PMID:29020103

  9. Morphometry of the coronary ostia and the structure of coronary arteries in the shorthair domestic cat.

    Directory of Open Access Journals (Sweden)

    Karolina Barszcz

    Full Text Available The aim of this study was to measure the area of the coronary ostia, assess their localization in the coronary sinuses and to determine the morphology of the stem of the left and right coronary arteries in the domestic shorthair cat. The study was conducted on 100 hearts of domestic shorthair cats of both sexes, aged 2-18 years, with an average body weight of 4.05 kg. A morphometric analysis of the coronary ostia was carried out on 52 hearts. The remaining 48 hearts were injected with a casting material in order to carry out a morphological assessment of the left and right coronary arteries. In all the studied animals, the surface of the left coronary artery ostium was larger than the surface of the right coronary artery ostium. There were four types of the left main coronary artery: type I (23 animals, 49%-double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch, which in turn gave off the septal branch, type II (12 animals, 26%-double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch without the septal branch, type III (11 animals, 23%-triple-branched left main stem (giving off the left circumflex branch, interventricular branch and the septal branch, type IV (1 animal, 2%-double-branched left main stem (giving off the interventricular paraconal branch and the left circumflex branch, which in turn gave off the septal branch. The left coronary artery ostium is greater than the right one. There is considerable diversity in the branches of proximal segment of the left coronary artery, while the right coronary artery is more conservative. These results can be useful in defining the optimal strategies in the endovascular procedures involving the coronary arteries or the aortic valve in the domestic shorthair cat.

  10. Risk of coronary artery disease in individuals infected with human immunodeficiency virus

    OpenAIRE

    Vilela, Felippe Dantas; Lorenzo, Andrea Rocha de; Tura, Bernardo Rangel; Ferraiuoli, Giovanna Ianini; Hadlich, Marcelo; Barros, Marcelo Viana de Lima; Lima, Ana Beatriz Ribeiro; Meirelles, Vanderson

    2011-01-01

    Current treatment for human immunodeficiency virus (HIV) infection has improved survival and allowed infected patients to develop atherosclerotic coronary artery disease (CAD). Specific strategies to reduce cardiovascular risk in the infected population have not been developed. It is necessary to know the magnitude of cardiovascular risk in this population. OBJECTIVES: This study aimed to assess cardiovascular risk using a well-known clinical score and to investigate coronary artery calcium s...

  11. Woven Coronary Artery Disease Successfully Managed with Percutaneous Coronary Intervention: A New Case Report

    Directory of Open Access Journals (Sweden)

    Yakup Alsancak

    2015-01-01

    Full Text Available Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication.

  12. Angiographic prevalence and pattern of coronary artery disease in women.

    Science.gov (United States)

    Ezhumalai, Babu; Jayaraman, Balachander

    2014-01-01

    There are not many studies describing the prevalence and pattern of "coronary artery disease" (CAD) in women undergoing "coronary angiography" (CAG). Hence, uncertainty thrives with regard to the angiographic prevalence and pattern of CAD in women. Our objective was to study the prevalence and pattern of CAD among women undergoing CAG. Data of 500 women who underwent CAG for suspected CAD over 3 years were retrospectively analyzed. They were classified into young group (age right coronary artery. Bifurcation lesion involving distal left main coronary artery is the most prevalent pattern of LMD. There has been a change with regard to clinical presentation and onset of risk factors for CAD at young age, but the load of atherosclerotic burden and pattern of involvement of coronary arteries have not changed in women. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  13. Differences in coronary artery disease by CT angiography between patients developing unstable angina pectoris vs. major adverse cardiac events

    Energy Technology Data Exchange (ETDEWEB)

    Schlett, Christopher L. [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg (Germany); Nance, John W. Jr. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); O’Brien, Terrence X. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (United States); Ebersberger, Ullrich [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); Department of Cardiology and Intensive Care Medicine, Heart Centre Munich-Bogenhausen, Munich (Germany); Headden, Gary F. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); Hoffmann, Udo [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Bamberg, Fabian [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Department of Radiology, University of Munich, Grosshadern Campus, and Munich Heart Alliance, Munich (Germany); Department of Radiology, University of Tuebingen (Germany)

    2014-07-15

    Highlights: • Patients developing UAP had overall more atherosclerosis as patients without any events. • Patients developing MACE had only more mixed plaque as those developing UAP. • Different atherosclerotic plaque components by CTA carry different prognostic value. - Abstract: Objective: CT angiography (CTA) has prognostic value in patients. But it is unknown whether differences in atherosclerosis by CTA predict the development of unstable angina pectoris (UAP) vs. major adverse cardiac events (MACE). Methods: We followed patients undergoing CTA as part of their acute chest pain work-up. Primary outcome was the development of UAP or MACE (cardiac death, myocardial infarction, revascularization) during a minimum follow-up of 12-months. CTAs were assessed for extent and composition of coronary plaque and stenosis. Ordinal regression with a 3-level outcome (no events, UAP, MACE) was applied. Results: Among 315 patients, 22 developed UAP and 31 MACE. While UAP patients had higher atherosclerosis burden with respect to all assessed features compared to patients with no events (p ≤ 0.02), only mixed plaque extent was significantly different between UAP and MACE patients (p = 0.02). The odds ratio was 4.55 for being in a higher disease-level comparing patients with low extent to those with no mixed plaque, and 3.02 comparing patients with high to those with low. These findings remained after adjustments for potential confounders. Conclusion: The extent of mixed coronary plaque is different between patients who develop UAP vs. MACE, supporting the hypothesis that it is a more culprit morphology.

  14. Predicting prolonged intensive care unit length of stay in patients undergoing coronary artery bypass surgery--development of an entirely preoperative scorecard.

    Science.gov (United States)

    Herman, Christine; Karolak, Wojtek; Yip, Alexandra M; Buth, Karen J; Hassan, Ansar; Légaré, Jean-Francois

    2009-10-01

    We sought to develop a predictive model based exclusively on preoperative factors to identify patients at risk for PrlICULOS following coronary artery bypass grafting (CABG). Retrospective analysis was performed on patients undergoing isolated CABG at a single center between June 1998 and December 2002. PrlICULOS was defined as initial admission to ICU exceeding 72 h. A parsimonious risk-predictive model was constructed on the basis of preoperative factors, with subsequent internal validation. Of 3483 patients undergoing isolated CABG between June 1998 and December 2002, 411 (11.8%) experienced PrlICULOS. Overall in-hospital mortality was higher among these patients (14.4% vs. 1.2%, Prisk predictive model of PrlICULOS in patients undergoing CABG was constructed. Based on preoperative clinical factors, a scorecard was developed allowing identification of these patients prior to surgery and allowing for strategies aimed at optimizing hospital resources.

  15. Mechanical characterization and constitutive modeling of the coronary artery

    NARCIS (Netherlands)

    Broek, van den C.N.

    2010-01-01

    Coronary heart disease is the most frequently occurring cardiovascular disease in Europe. The components of the arterial wall are strongly related to the arterial mechanical behavior, and the composition may change because of remodeling processes that take place in the arterial wall, upon disease or

  16. Etiologies of coronary artery disease in cancer patients

    International Nuclear Information System (INIS)

    Kopelson, G.; Herwig, K.J.

    1978-01-01

    The growing number of patient reports of angina and myocardial infarction during cancer management prompted this review of coronary artery disease (CAD) in cancer patients. There is no definite evidence that cancer per se nor any particular tumor type predisposes to coronary atherosclerosis. Cardiac metastases can cause CAD via tumor emboli, extrinsic compression, or ostial obstruction; in these patients the diagnosis of CAD as a result of cardiac metastases often is not made until death. The course of these patients usually is fulminant. Tumor-associated coagulation disorders and non-bacterial thrombotic endocarditis can cause coronary thromboemboli; treatment should be initiated early as these patients often are not in a terminal state when such CAD develops. Post-radiation CAD seen in experimental animals (via fibrosis and/or accelerated atherogenesis) can be extrapolated to the clinical situation. This is best evidenced by 10 young patients, with minimal coronary risk factors in most, who developed angina and/or myocardial infarction 2 to 100 months after chest radiotherapy; approximate mediastinal doses ranged from 1440 Roentgen to 5075 rad. In 5 patients there was no significant atherosclerosis beyond the radiation portals; 2 had successful saphenous vein bypass grafts. Lipid-lowering therapy may prevent post-radiotherapy atherogenesis in high risk individuals. Chemotherapy (acting directly or synergistically with radiotherapy) has caused angina and myocardial infarction within hours to days after the infusion of agents both classically cardiotoxic as well as others, although the exact mechanism(s) for coronary artery damage as a result of chemotherapy presently is unknown

  17. C-reactive protein for predicting prognosis and its gender-specific associations with diabetes mellitus and hypertension in the development of coronary artery spasm.

    Science.gov (United States)

    Hung, Ming-Jui; Hsu, Kuang-Hung; Hu, Wei-Syun; Chang, Nen-Chung; Hung, Ming-Yow

    2013-01-01

    While hypertension is negatively associated with coronary artery spasm (CAS), scarce data are available on diabetes mellitus in relation to CAS. In addition, outcome prediction in patients with CAS is challenging due to the lack of appropriate biomarkers. Therefore, we sought to identify the roles that gender, high-sensitivity C-reactive protein (hs-CRP), diabetes mellitus and hypertension play in CAS development and prognosis. Patients (350 women and 547 men) undergoing diagnostic coronary angiography with or without proven CAS but without obstructive stenosis were evaluated at long-term follow-up (median 102 months). Diabetic women and diabetic men with low hs-CRP levels had a low and high risk of CAS (odds ratio [OR]: 0.16, 95% confidence interval [CI]: 0.01-1.88 and OR: 5.02, 95% CI: 1.03-24.54, respectively). The ORs of CAS in both women and men with the highest hs-CRP tertile (>3 mg/L) reduced from 4.41 to 1.45 and 2.98 to 1.52, respectively, if they had diabetes mellitus, and from 9.68 to 2.43 and 2.60 to 1.75, respectively, if they had hypertension. Hypertension had a more negative effect on CAS development in diabetic than non-diabetic women, which was not observed in men. The highest hs-CRP tertile was an independent predictor of adverse outcomes. Patients with the highest hs-CRP tertile had more coronary events than patients with the lowest hs-CRP tertitle (p = 0.021, log-rank test). Diabetes mellitus contributes to CAS development in men with low hs-CRP levels, but not in women. There are negative effects of diabetes mellitus and hypertension on CAS development in patients with high hs-CRP levels and especially in women. Elevated hs-CRP level independently predicts adverse outcomes.

  18. Betel nut usage is a major risk factor for coronary artery disease.

    Science.gov (United States)

    Khan, Muhammad Shahzeb; Bawany, Faizan Imran; Ahmed, Muhammad Umer; Hussain, Mehwish; Khan, Asadullah; Lashari, Muhammad Nawaz

    2013-12-27

    The objective of our study was to assess betel nut usage as one of the major risk factors associated with coronary artery disease. This case control study consisted of 300 controls and 300 cases. A structured questionnaire was administered to the participants to assess consumption of betel nut and confounding variables. A respondent was considered a regular consumer of betel nut if he/she consumed one or more pieces of betel nut every day for a period of greater than 6 months. About 8 in 10 betel nut chewers developed coronary artery disease. After adjusting for diabetes and hypertension, the odds ratio analysis depicted 7.72 times greater likelihood for coronary artery disease in patients who chewed betel nut for more than 10 years. Our study concludes that betel nut chewing is a significant risk factor leading to the development of coronary artery disease.

  19. Posttraumatic growth in post-surgical coronary artery bypass graft patients

    Directory of Open Access Journals (Sweden)

    Catherine A Waight

    2015-02-01

    Full Text Available Recent research in posttraumatic growth has been applied to people with life-threatening illnesses to optimise recovery. There is a lack of research exploring posttraumatic growth in coronary artery bypass graft patients. This article describes the recovery experience of 14 coronary artery bypass graft patients (13 males and 1 female at their first outpatient review post-surgery. Grounded theory analysis was used to develop a model of distinct and shared pathways to growth depending on whether patients were symptomatic or asymptomatic pre-coronary artery bypass graft. Outcomes of posttraumatic growth in this sample included action-based healthy lifestyle growth and two forms of cognitive growth: appreciation of life and new possibilities. The model of posttraumatic growth developed in this study may be helpful in guiding future research into promoting posttraumatic growth and behaviour change in coronary artery bypass graft patients.

  20. Toward the automatic detection of coronary artery calcification in non-contrast computed tomography data.

    Science.gov (United States)

    Brunner, Gerd; Chittajallu, Deepak R; Kurkure, Uday; Kakadiaris, Ioannis A

    2010-10-01

    Measurements related to coronary artery calcification (CAC) offer significant predictive value for coronary artery disease (CAD). In current medical practice CAC scoring is a labor-intensive task. The objective of this paper is the development and evaluation of a family of coronary artery region (CAR) models applied to the detection of CACs in coronary artery zones and sections. Thirty patients underwent non-contrast electron-beam computed tomography scanning. Coronary artery trajectory points as presented in the University of Houston heart-centered coordinate system were utilized to construct the CAR models which automatically detect coronary artery zones and sections. On a per-patient and per-zone basis the proposed CAR models detected CACs with a sensitivity, specificity and accuracy of 85.56 (± 15.80)%, 93.54 (± 1.98)%, and 85.27 (± 14.67)%, respectively while the corresponding values in the zones and segments based case were 77.94 (± 7.78)%, 96.57 (± 4.90)%, and 73.58 (± 8.96)%, respectively. The results of this study suggest that the family of CAR models provide an effective method to detect different regions of the coronaries. Further, the CAR classifiers are able to detect CACs with a mean sensitivity and specificity of 86.33 and 93.78%, respectively.

  1. Coronary artery calcium scoring in myocardial infarction

    International Nuclear Information System (INIS)

    Beslic, S.; Dalagija, F.

    2005-01-01

    Background. The aim of this study was to evaluate coronary artery calcium scoring and the assessment of the risk factors in patients with myocardial infarction (MI). Methods. During the period of three years, 27 patients with MI were analyzed. The average age of patients was 66.1 years (46 to 81). Coronary arteries calcium was evaluated by multi row detector computed tomography (MTDC) S omatom Volume Zoom Siemens , and, retrospectively by ECG gating data acquisition. Semi automated calcium quantification to calculate Agatston calcium score (CS) was performed with 4 x 2.5 mm collimation, using 130 ml of contrast medium, injected with an automatic injector, with the flow rate of 4 ml/sec. The delay time was determined empirically. At the same time several risk factors were evaluated. Results. Out of 27 patients with MI, 3 (11.1%) patients had low CS (10- 100), 5 (18.5%) moderate CS (101- 499), and 19 (70.4%) patients high CS (>500). Of risk factors, smoking was confirmed in 17 (63.0%), high blood pressure (HTA) in 10 (57.0%), diabetes mellitus in 7 (25.9%), positive family history in 5 (18.5%), pathological lipids in 5 (18.5%), alcohol abuse in 4 (1.8%) patients. Six (22.2%) patients had symptoms of angina pectoris. Conclusions. The research showed high correlation of MI and high CS (>500). Smoking, HTA, diabetes mellitus, positive family history and hypercholesterolemia are significant risk factors. Symptoms are relatively poor in large number of patients. (author)

  2. A Review of Coronary Artery Disease Research in Malaysia.

    Science.gov (United States)

    Ang, C S; Chan, K M J

    2016-06-01

    Coronary artery disease is the major cause of mortality and morbidity in Malaysia and worldwide. This paper reviews all research and publications on coronary artery disease in Malaysia published between 2000-2015. 508 papers were identified of which 146 papers were selected and reviewed on the basis of their relevance. The epidemiology, etiology, risk factors, prevention, assessment, treatment, and outcomes of coronary artery disease in the country are reviewed and summarized. The clinical relevance of the studies done in the country are discussed along with recommendations for future research.

  3. The human coronary collateral circulation: development and clinical importance.

    Science.gov (United States)

    Seiler, Christian; Stoller, Michael; Pitt, Bertram; Meier, Pascal

    2013-09-01

    Coronary collaterals are an alternative source of blood supply to myocardium jeopardized by ischaemia. In comparison with other species, the human coronary collateral circulation is very well developed. Among individuals without coronary artery disease (CAD), there are preformed collateral arteries preventing myocardial ischaemia during a brief vascular occlusion in 20-25%. Determinants of such anastomoses are low heart rate and the absence of systemic arterial hypertension. In patients with CAD, collateral arteries preventing myocardial ischaemia during a brief occlusion are present in every third individual. Collateral flow sufficient to prevent myocardial ischaemia during coronary occlusion amounts to one-fifth to one-fourth the normal flow through the open vessel. Myocardial infarct size, the most important prognostic determinant after such an event, is the product of coronary artery occlusion time, area at risk for infarction, and the inverse of collateral supply. Well-developed coronary collateral arteries in patients with CAD mitigate myocardial infarcts and improve survival. Approximately one-fifth of patients with CAD cannot be revascularized by percutaneous coronary intervention or coronary artery bypass grafting. Therapeutic promotion of collateral growth is a valuable treatment strategy in those patients. It should aim at growth of large conductive collateral arteries (arteriogenesis). Potential arteriogenic approaches include the treatment with granulocyte colony-stimulating factor, physical exercise training, and external counterpulsation.

  4. The influence of contrast media on kidney function in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Reuter, Simon Bertram; Harutyunyan, Marina; Mygind, Naja Dam

    2014-01-01

    AIMS: To investigate the incidence of contrast media-induced nephropathy (CIN) in patients with stable coronary artery disease (CAD) referred for elective coronary intervention following hydration routines. The reversibility of CIN was followed in a 6 month-period. METHODS AND RESULTS: A total...... coronary interventions. Kidney function and the amount of contrast media used was not a predictor of CIN development. The induced CIN was not completely normalized in a 6-month follow-up period....

  5. Cyanotic Congenital Heart Disease The Coronary Arterial Circulation

    Science.gov (United States)

    Perloff, Joseph K

    2012-01-01

    Background: The coronary circulation in cyanotic congenital heart disease (CCHD) includes the extramural coronary arteries, basal coronary blood flow, flow reserve, the coronary microcirculation, and coronary atherogenesis. Methods: Coronary arteriograms were analyzed in 59 adults with CCHD. Dilated extramural coronaries were examined histologically in six patients. Basal coronary blood flow was determined with N-13 positron emission tomography in 14 patients and in 10 controls. Hyperemic flow was induced by intravenous dipyridamole pharmacologic stress. Immunostaining against SM alpha-actin permitted microcirculatory morphometric analysis. Non-fasting total cholesterols were retrieved in 279 patients divided into four groups: Group A---143 cyanotic unoperated, Group B---47 rendered acyanotic by reparative surgery, Group C---41 acyanotic unoperated, Group D---48 acyanotic before and after operation. Results: Extramural coronary arteries were mildly or moderately dilated to ectatic in 49/59 angiograms. Histologic examination disclosed loss of medial smooth muscle, increased medial collagen, and duplication of internal elastic lamina. Basal coronary flow was appreciably increased. Hyperemic flow was comparable to controls. Remodeling of the microcirculation was based upon coronary arteriolar length, volume and surface densities. Coronary atherosclerosis was absent in both the arteriograms and the necropsy specimens. Conclusions: Extramural coronary arteries in CCHD dilate in response to endothelial vasodilator substances supplemented by mural attenuation caused by medial abnormalities. Basal coronary flow was appreciably increased, but hyperemic flow was normal. Remodeling of the microcirculation was responsible for preservation of flow reserve. The coronaries were atheroma-free because of the salutory effects of hypocholesterolemia, hypoxemia, upregulated nitric oxide, low platelet counts, and hyperbilirubinrmia. PMID:22845810

  6. Healthy lifestyle through young adulthood and the presence of low cardiovascular disease risk profile in middle age: the Coronary Artery Risk Development in (Young) Adults (CARDIA) study.

    Science.gov (United States)

    Liu, Kiang; Daviglus, Martha L; Loria, Catherine M; Colangelo, Laura A; Spring, Bonnie; Moller, Arlen C; Lloyd-Jones, Donald M

    2012-02-28

    A low cardiovascular disease risk profile (untreated cholesterol risk profile. We examined whether adopting a healthy lifestyle throughout young adulthood is associated with the presence of the low cardiovascular disease risk profile in middle age. The Coronary Artery Risk Development in (Young) Adults (CARDIA) study sample consisted of 3154 black and white participants 18 to 30 years of age at year 0 (1985-1986) who attended the year 0, 7, and 20 examinations. Healthy lifestyle factors defined at years 0, 7, and 20 included average body mass index risk profile at year 20 were 3.0%, 14.6%, 29.5%, 39.2%, and 60.7% for people with 0 or 1, 2, 3, 4, and 5 healthy lifestyle factors, respectively (P for trend risk profile in middle age. Public health and individual efforts are needed to improve the adoption and maintenance of healthy lifestyles in young adults.

  7. Development of a blood-based gene expression algorithm for assessment of obstructive coronary artery disease in non-diabetic patients

    Directory of Open Access Journals (Sweden)

    Ellis Stephen G

    2011-03-01

    Full Text Available Abstract Background Alterations in gene expression in peripheral blood cells have been shown to be sensitive to the presence and extent of coronary artery disease (CAD. A non-invasive blood test that could reliably assess obstructive CAD likelihood would have diagnostic utility. Results Microarray analysis of RNA samples from a 195 patient Duke CATHGEN registry case:control cohort yielded 2,438 genes with significant CAD association (p RT-PCR analysis of these 113 genes in a PREDICT cohort of 640 non-diabetic subject samples was used for algorithm development. Gene expression correlations identified clusters of CAD classifier genes which were reduced to meta-genes using LASSO. The final classifier for assessment of obstructive CAD was derived by Ridge Regression and contained sex-specific age functions and 6 meta-gene terms, comprising 23 genes. This algorithm showed a cross-validated estimated AUC = 0.77 (95% CI 0.73-0.81 in ROC analysis. Conclusions We have developed a whole blood classifier based on gene expression, age and sex for the assessment of obstructive CAD in non-diabetic patients from a combination of microarray and RT-PCR data derived from studies of patients clinically indicated for invasive angiography. Clinical trial registration information PREDICT, Personalized Risk Evaluation and Diagnosis in the Coronary Tree, http://www.clinicaltrials.gov, NCT00500617

  8. Systolic Compression of Epicardial Coronary and Intramural Arteries

    Science.gov (United States)

    Mohiddin, Saidi A.; Fananapazir, Lameh

    2002-01-01

    It has been suggested that systolic compression of epicardial coronary arteries is an important cause of myocardial ischemia and sudden death in children with hypertrophic cardiomyopathy. We examined the associations between sudden death, systolic coronary compression of intra- and epicardial arteries, myocardial perfusion abnormalities, and severity of hypertrophy in children with hypertrophic cardiomyopathy. We reviewed the angiograms from 57 children with hypertrophic cardiomyopathy for the presence of coronary and septal artery compression; coronary compression was present in 23 (40%). The left anterior descending artery was most often affected, and multiple sites were found in 4 children. Myocardial perfusion abnormalities were more frequently present in children with coronary compression than in those without (94% vs 47%, P = 0.002). Coronary compression was also associated with more severe septal hypertrophy and greater left ventricular outflow gradient. Septal branch compression was present in 65% of the children and was significantly associated with coronary compression, severity of septal hypertrophy, and outflow obstruction. Multivariate analysis showed that septal thickness and septal branch compression, but not coronary compression, were independent predictors of perfusion abnormalities. Coronary compression was not associated with symptom severity, ventricular tachycardia, or a worse prognosis. We conclude that compression of coronary arteries and their septal branches is common in children with hypertrophic cardiomyopathy and is related to the magnitude of left ventricular hypertrophy. Our findings suggest that coronary compression does not make an important contribution to myocardial ischemia in hypertrophic cardiomyopathy; however, left ventricular hypertrophy and compression of intramural arteries may contribute significantly. (Tex Heart Inst J 2002;29:290–8) PMID:12484613

  9. Surgical revascularization of posterior coronary arteries without cardiopulomonary bypass

    Directory of Open Access Journals (Sweden)

    Lobo Filho J. Glauco

    1999-01-01

    Full Text Available OBJECTIVE: To assess the results observed during the early postoperative period in patients who had the posterior coronary arteries revascularized without cardiopulmonary bypass (CPB, in regard to the following parameters: age, sex,bypass grafts types, morbidity and mortality. METHODS: From January 1995 to June 1998, 673 patients underwent myocardial revascularization (MR. Of this total, 607 (90.20% MR procedures were performed without CPB. The posterior coronary arteries (PCA were revascularized in 298 (44.27% patients, 280 (93.95% without CPB. The age of the patients ranged from 37 to 88 years (mean, 61 years. The male gender predominated, with 198 men (70.7%. The revascularization of the posterior coronary arteries had the following distribution: diagonalis artery (31 patients, 10%; marginal branches of the circumflex artery (243 patients, 78.7%; posterior ventricular artery (4 patients, 1.3%; and posterior descending artery (31 patients, 10%. RESULTS: Procedure-related complications without death occurred in 7 cases, giving a morbidity of 2.5%. There were 11 deaths in the early postoperative period (mortality of 3.9%. CONCLUSION: Similarly to the anterior coronary arteries, the posterior coronary arteries may benefit from myocardial revascularization without CPB.

  10. Evaluation of coronary artery disease by helical CT using retrospective ECG-gating

    International Nuclear Information System (INIS)

    Kawawa, Yoko

    2001-01-01

    The purpose of this study is to evaluate the usefulness of helical CT using retrospective ECG-gating for visualization of the coronary artery and detection of coronary artery disease. We performed a coronary artery phantom study and established this new application, with 1-mm collimation, 1-mm table increment, and 0.1-mm reconstruction (0.8 sec/rotation). Helical CT of 31 patients with 39 coronary artery diseases (34 coronary artery stenoses, 1 vasospastic angina, 1 coronary artery dissection, 1 coronary artery ectasia and 2 coronary artery aneurysms) was performed in a single breath hold and ECG-gating without and with intravenous injection of nonionic iodine contrast material. We selected the images which were not affected by cardiac motion from the reconstruction images, in order to visualize the coronary artery for detection of coronary artery disease. The coronary artery was well visualized in 32 out of 39 vessels (82%). A good visualization of the coronary artery was correlated with the heart rate. Further, in this well visualized group, coronary artery diseases were detected in 24 out of 31 cases (77%). One case of vasospastic angina was not included. It was difficult to detect coronary artery disease in cases of heavily calcified vessels or in the left circumflex artery. Helical CT using this retrospective ECG-gating is a useful noninvasive examination for evaluation of coronary artery disease. (author)

  11. Evaluation of coronary artery bypass grafts with magnetic resonance imaging

    International Nuclear Information System (INIS)

    Okamura, Yoshitaka; Yamada, Yasuyuki; Mochizuki, Yoshihiko; Iida, Hiroshi; Mori, Hideaki; Sugita, You-ichi; Shimada, Kou-ichirou

    1997-01-01

    Currently, the efficacy of magnetic resonance imaging (MRI) for evaluating coronary artery disease has been reported. In this study, we have evaluated the usefulness and the problems of MRI for evaluating the patency of coronary artery bypass grafts. Thirty-five patients who received coronary artery bypass grafting (CABG) were evaluated by using MRI for determining the graft patency compared with conventional coronary angiography. There were 30 men and 5 women. The mean age was 61.2 years (range 45 to 75). The 35 patients had a total of 92 grafts (28 internal thoracic artery, 7 gastroepiploic artery and 57 saphenous vein grafts). Magnetic resonance coronary angiogram (MRCA) was performed with SIGNA HORIZON 1.5 T (GE Inc.) by using 2D-FASTCARD sequence. All patients underwent imaging in the transverse and coronal planes, most had imaging in the sagittal plane, and a few had in the oblique plane. By using MRCA, 82 of 90 grafts were diagnosed correctly as patent, and 1 of 2 grafts were diagnosed correctly as occluded. Thirty-four of 40 LAD grafts (85%), 20 of 22 RCA grafts (91%) and 29 of 30 Cx grafts (97%) were correctly evaluated. The efficacy of MRCA for evaluating the patency of coronary artery bypass grafts was recognized. But the sternal wire (stainless steel) and hemoclip interfere with the interpretation and reduce the sensitivity. Higher sensitivity may be obtained by changing the material of the sternal wires and hemoclips at coronary surgery. (author)

  12. Factors influencing delay time and coronary arterial density during coronary angiography with DSCT

    International Nuclear Information System (INIS)

    Lijun Tang; Xiaomei Zhu; Yi Xu; Tongfu Yu; Hai Xu; Jinhua Tang; Dehang Wang; Dogra, Vikram

    2011-01-01

    Background: CT angiography (CTA) plays an important role in diagnosing coronary arterial disease. Delay time and density of the coronary arteries related with patient-specific factors are essential for getting an optimal CTA image. Purpose: To investigate various factors influencing delay time and coronary arterial density during coronary CTA with dual source CT. Material and Methods: One hundred and sixteen consecutive subjects who underwent cardiac DSCT with retrospective ECG-gating were included. Factors including gender, age, height, weight, transversal cardiac diameter (TCD), transversal thoracic diameter (TTD), heart rate (HR), body surface area (BSA = [weight x height/3600]1/2) and cardiothoracic ratio (CTR = TCD/TTD) were recorded, measured and calculated before administration of contrast media during coronary CT angiography. Delay time was determined as duration from the beginning of the injection to the density in the descending aorta at the level of right main pulmonary artery reaching a threshold of 100 HU. Coronary arterial density was measured at the mid portion of the right coronary artery. Regression analysis and stepwise regression analysis were used to investigate the influence of these factors on delay time and coronary arterial density. Results: Delay time decreased with an increasing HR and it was shorter in women than men. Delay time increased with an increasing TCD. Delay time could be predicted by the formula: DT = 16.651-0.110 x HR + 1.902 x gender + 0.394 x TCD (where DT is abbreviation for delay time, gender is 0 for women and 1 for men). Coronary arterial density decreased with an increasing HR and weight. Coronary arterial density could be predicted by the formula: CAD = 923.42-4.099 x HR-3.293 x weight (CAD = coronary arterial density). There was no relationship between the other factors mentioned above and delay time or coronary arterial density. Conclusion: Delay time is influenced by HR, gender and TCD. Coronary arterial density

  13. Factors influencing delay time and coronary arterial density during coronary angiography with DSCT.

    Science.gov (United States)

    Tang, Lijun; Zhu, Xiaomei; Xu, Yi; Yu, Tongfu; Xu, Hai; Tang, Jinhua; Dogra, Vikram; Wang, Dehang

    2011-02-01

    CT angiography (CTA) plays an important role in diagnosing coronary arterial disease. Delay time and density of the coronary arteries related with patient-specific factors are essential for getting an optimal CTA image. To investigate various factors influencing delay time and coronary arterial density during coronary CTA with dual source CT. One hundred and sixteen consecutive subjects who underwent cardiac DSCT with retrospective ECG-gating were included. Factors including gender, age, height, weight, transversal cardiac diameter (TCD), transversal thoracic diameter (TTD), heart rate (HR), body surface area (BSA = [weight × height/3600](1/2)) and cardiothoracic ratio (CTR = TCD/TTD) were recorded, measured and calculated before administration of contrast media during coronary CT angiography. Delay time was determined as duration from the beginning of the injection to the density in the descending aorta at the level of right main pulmonary artery reaching a threshold of 100 HU. Coronary arterial density was measured at the mid portion of the right coronary artery. Regression analysis and stepwise regression analysis were used to investigate the influence of these factors on delay time and coronary arterial density. Delay time decreased with an increasing HR and it was shorter in women than men. Delay time increased with an increasing TCD. Delay time could be predicted by the formula: DT = 16.651-0.110 × HR + 1.902 × gender + 0.394 × TCD (where DT is abbreviation for delay time, gender is 0 for women and 1 for men). Coronary arterial density decreased with an increasing HR and weight. Coronary arterial density could be predicted by the formula: CAD = 923.42-4.099 × HR-3.293 × weight (CAD = coronary arterial density). There was no relationship between the other factors mentioned above and delay time or coronary arterial density. Delay time is influenced by HR, gender and TCD. Coronary arterial density also changes with HR and weight. So HR, gender, TCD and

  14. Antral follicle count predicts natural menopause in a population-based sample: the Coronary Artery Risk Development in Young Adults Women's Study.

    Science.gov (United States)

    Wellons, Melissa F; Bates, Gordon Wright; Schreiner, Pamela J; Siscovick, David S; Sternfeld, Barbara; Lewis, Cora E

    2013-08-01

    The timing of menopause is associated with multiple chronic diseases. Tools that predict this milestone have relevance for clinical and research purposes. Among infertile women, a positive relationship exists between antral follicle count (AFC) and response to controlled ovarian hyperstimulation, a marker of ovarian reserve. However, an age-independent relationship between AFC and menopause has not been demonstrated. Thus, our objective was to evaluate the relationship between AFC measured in women aged 34 to 49 years and incident natural menopause during 7 years of follow-up. The Coronary Artery Risk Development in Young Adults Study is a longitudinal community-based study (Chicago, IL; Birmingham, AL; Minneapolis, MN; and Oakland, CA) begun in 1985-1986. In 2002-2003, the Coronary Artery Risk Development in Young Adults Women's Study measured follicle-stimulating hormone (FSH) levels and performed a transvaginal ultrasound protocol that included AFC (2-10 mm follicles on both ovaries). Incident natural menopause was assessed by surveys in 2005-2006 and 2009-2010. In our sample (n = 456), the median (interquartile range) AFC and FSH level were 5 (2-9) and 7.8 (5.6-11.0) mIU/mL, respectively, at a mean (range) age of 42 (34-49) years in 2002-2003. One hundred one women reported natural menopause by 2009-2010. In Cox models, current smoking, stable menses, FSH level higher than 13 mIU/mL, and AFC of 4 or less were independently associated with incident natural menopause. Compared with AFC higher than 4, those with an AFC of 4 or less were nearly twice as likely to have undergone menopause during 7 years of follow-up (hazard ratio, 1.89; 95% CI, 1.19-3.02) after adjustment for covariates. AFC has been found to be independently associated with natural menopause during 7 years of follow-up after controlling for other markers of ovarian aging.

  15. Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multislice CT findings

    International Nuclear Information System (INIS)

    Goo, Hyun Woo; Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun; Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee

    2009-01-01

    In patients with congenital heart disease, coronary artery anomalies are common and have different clinical importance from individuals with structurally normal hearts. Visibility of the coronary arteries by CT has markedly improved due to high temporal resolution and ECG-synchronized data acquisition. In this article we describe current multislice CT techniques for coronary artery imaging and illustrate coronary artery anomalies and clinically important coronary artery anatomy from the point of view of congenital heart disease. (orig.)

  16. Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multislice CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea); Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun [University of Ulsan College of Medicine, Department of Pediatric Cardiac Surgery, Asan Medical Center, Seoul (Korea); Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee [University of Ulsan College of Medicine, Department of Pediatric Cardiology, Asan Medical Center, Seoul (Korea)

    2009-03-15

    In patients with congenital heart disease, coronary artery anomalies are common and have different clinical importance from individuals with structurally normal hearts. Visibility of the coronary arteries by CT has markedly improved due to high temporal resolution and ECG-synchronized data acquisition. In this article we describe current multislice CT techniques for coronary artery imaging and illustrate coronary artery anomalies and clinically important coronary artery anatomy from the point of view of congenital heart disease. (orig.)

  17. Congenital coronary artery anomalies: a bridge from embryology to anatomy and pathophysiology--a position statement of the development, anatomy, and pathology ESC Working Group

    NARCIS (Netherlands)

    Pérez-Pomares, José María; de la Pompa, José Luis; Franco, Diego; Henderson, Deborah; Ho, Siew Yen; Houyel, Lucile; Kelly, Robert G.; Sedmera, David; Sheppard, Mary; Sperling, Silke; Thiene, Gaetano; van den Hoff, Maurice; Basso, Cristina

    2016-01-01

    Congenital coronary artery anomalies are of major significance in clinical cardiology and cardiac surgery due to their association with myocardial ischaemia and sudden death. Such anomalies are detectable by imaging modalities and, according to various definitions, their prevalence ranges from 0.21

  18. Interferon-beta signaling is enhanced in patients with insufficient coronary collateral artery development and inhibits arteriogenesis in mice

    NARCIS (Netherlands)

    Schirmer, Stephan H.; Fledderus, Joost O.; Moerland, Perry D.; Hoefer, Imo E.; Henriques, Jose P. S.; van der Schaaf, Rene J.; Vis, Marije M.; Horrevoets, Anton J. G.; Piek, Jan J.; van Royen, Niels; Baan, J.

    2008-01-01

    Stimulation of collateral artery growth in patients has been hitherto unsuccessful, despite promising experimental approaches. Circulating monocytes are involved in the growth of collateral arteries, a process also referred to as arteriogenesis. Patients show a large heterogeneity in their natural

  19. Accurate Prediction of Coronary Artery Disease Using Bioinformatics Algorithms

    Directory of Open Access Journals (Sweden)

    Hajar Shafiee

    2016-06-01

    Full Text Available Background and Objectives: Cardiovascular disease is one of the main causes of death in developed and Third World countries. According to the statement of the World Health Organization, it is predicted that death due to heart disease will rise to 23 million by 2030. According to the latest statistics reported by Iran’s Minister of health, 3.39% of all deaths are attributed to cardiovascular diseases and 19.5% are related to myocardial infarction. The aim of this study was to predict coronary artery disease using data mining algorithms. Methods: In this study, various bioinformatics algorithms, such as decision trees, neural networks, support vector machines, clustering, etc., were used to predict coronary heart disease. The data used in this study was taken from several valid databases (including 14 data. Results: In this research, data mining techniques can be effectively used to diagnose different diseases, including coronary artery disease. Also, for the first time, a prediction system based on support vector machine with the best possible accuracy was introduced. Conclusion: The results showed that among the features, thallium scan variable is the most important feature in the diagnosis of heart disease. Designation of machine prediction models, such as support vector machine learning algorithm can differentiate between sick and healthy individuals with 100% accuracy.

  20. Should the patient with coronary artery disease use sildenafil?

    Science.gov (United States)

    Cheitlin, Melvin D

    2003-01-01

    Since the etiology of erectile dysfunction is frequently related to endothelial dysfunction, a problem in common with much vascular disease, erectile dysfunction disproportionately affects patients with cardiovascular disease. With the development of phosphodiesterase 5 inhibitors, the first of which was sildenafil (Viagra), an effective oral medication became available. The question of safety of these drugs, especially in patients with latent or overt coronary artery disease, is of concern. Sildenafil relaxes smooth muscle and therefore lowers systolic and diastolic blood pressure slightly. With organic nitrates, the drop in blood pressure is potentiated, at times dangerously, thereby making it contraindicated to take nitrates within 24 hours of using sildenafil. In double-blind, placebo-controlled trials, there was no difference between sildenafil subjects and control patients in the incidence of myocardial infarction, cardiovascular, and total deaths. Coronary disease patients with stable angina, controlled on medications, were included in the trials. Therefore, sildenafil, as a drug, is safe in such patients. With a patient with coronary artery disease suddenly engaging in the physical exercise associated with sexual intercourse, there is the danger of increased risk of precipitating myocardial infarction or death. The cardiovascular metabolic cost of sexual activity is reviewed and appears to be approximately at the level of 3-5 metabolic equivalents of exercise. Sexual activity occurs within 2 hours of the onset of an acute myocardial infarction in life will be markedly improved by their ability to engage in sexual activity.

  1. Matrix metalloproteinase gene polymorphisms in patients with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Vanessa L.N. Dalepiane

    2007-01-01

    Full Text Available Matrix metalloproteinases (MMPs play an important role in the pathogenesis of atherosclerosis, the pathology underlying the majority of coronary artery disease (CAD. In this study we tested the hypothesis that polymorphic variation in the MMP genes influences the risk of developing atherosclerosis. We analyzed functional polymorphisms in the promoter of the MMP-1, MMP-3, MMP-9 and MMP-12 genes in 183 Brazilian Caucasian individuals submitted to coronary angiography, of which 67 (37% had normal coronary arteries (control group and 116 (63% had CAD (CAD patient group. The -1607 1G/2G MMP-1, -1171 5A/6A MMP-3, -1562 C/T MMP-9, -82 A/G MMP-12 polymorphisms were analyzed by PCR followed by restriction digestion. No significant differences were observed in allele frequencies between the CAD patients and controls. Haplotype analysis showed no differences between the CAD patients and controls. There was a significant difference in the severity of CAD, as assessed by the number of diseased vessels, in MMP-1 1G/1G homozygous individuals and in those homozygous for the 6A allele of the MMP-3 polymorphism. However, multivariate analysis showed that diabetes mellitus was the only variable independently associated with CAD severity. Our findings indicated that MMP polymorphisms have no significant impact on the risk and severity of CAD.

  2. Correlation study on waist circumference-triglyceride (WT) index and coronary artery scores in patients with coronary heart disease.

    Science.gov (United States)

    Yang, R-F; Liu, X-Y; Lin, Z; Zhang, G

    2015-01-01

    Coronary disease is analyzed through common lipid profiles, but these analyses fail to account for residual risk due to abdominal weight and elevated TG levels. We aimed to investigate the relationship between the waist circumference × triglyceride index (WT index) and the Coronary Artery Score (CAS) in patients with coronary heart disease. 346 patients in our Cardiology Department were recruited from September 2007 to August 2011 and divided into two groups according to whether the patients presented with metabolic syndrome. We performed coronary angiography using the standard Judkins method. The severity of coronary artery stenosis and the CAS were calculated and analyzed with a computerized quantitative analysis system. The signs index, which includes the body mass index (BMI), waist circumference, hip circumference, waist-hip-ratio, and waist-height-ratio, the blood glucose and blood lipid index of all the patients were collected and used to calculate the WT index (waist circumference x triglyceride index. We performed a correlative analysis with age, gender, body mass index, blood glucose and blood lipid, blood pressure and other risk indicators of all patients as the dependent variables and the CAS as the independent variable. We show that the CAS is positively correlated to the WT index. Several lipid profiles and waist circumference were significantly associated with the CAS. The WT index is correlated to the CAS and is a good predictor for the development of coronary artery disease; it can be applied in the clinic for early intervention in populations at risk for coronary heart disease.

  3. Multiple giant coronary aneurysms arising from coronary istula to the pulmonary artery revealed in aorta CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Eun Ju; Lee, Ki Nam [Dept. of Radiology, Dong A University Hospital, Dong-A University College of Medicine, Busan (Korea, Republic of); Lee, Jong Min [Dept. of Radiology, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Daegu (Korea, Republic of)

    2015-12-15

    Coronary fistula is a rare coronary abnormality through which blood drains into the cardiac chamber, great vessel or other vessels. In addition, giant aneurysm arising from coronary fistula is rare pathologic manifestation. Herein, we presented a rare case of multiple giant coronary artery aneurysms arising from coronary to pulmonary artery fistula in a 79-year-old woman presenting with sudden loss of consciousness. The aneurysms were detected using thoracic computed tomography angiography and consequently confirmed by invasive coronary angiography.

  4. Interaction between smoking and depressive symptoms with subclinical heart disease in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

    Science.gov (United States)

    Carroll, Allison J; Carnethon, Mercedes R; Liu, Kiang; Jacobs, David R; Colangelo, Laura A; Stewart, Jesse C; Carr, J Jeffrey; Widome, Rachel; Auer, Reto; Hitsman, Brian

    2017-02-01

    Evaluate whether smoking exposure and depressive symptoms accumulated over 25 years are synergistically associated with subclinical heart disease, measured by coronary artery calcification (CAC). Participants (baseline: 54.5% women; 51.5% Black; age range = 18-30 years) were followed prospectively from 1985 to 2010 in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Smoking status was queried yearly from Year 0 to Year 25 to compute packyears of smoking exposure. Depressive symptoms were measured on the Center for Epidemiologic Studies Depression (CES-D) scale every 5 years to compute cumulative scores from Year 5 to Year 25. A three-level multinomial logistic regression was used to evaluate the association between cumulative smoking, cumulative depressive symptoms, and their interaction with moderate-risk CAC (score 1-99) and higher-risk CAC (score ≥100) compared with no CAC (score = 0) at Year 25. Models were adjusted for sociodemographic, clinical, and behavioral covariates. Among 3,189 adults, the cumulative Smoking × Depressive Symptoms interaction was not significant for moderate-risk CAC (p = .057), but was significant for higher-risk CAC (p = .001). For adults with a 30-packyear smoking history, average CES-D scores 2, 10, and 16 were, respectively, associated with odds ratios (95% confidence intervals) 3.40 (2.36-4.90), 4.82 (3.03-7.66), and 6.25 (3.31-11.83) for higher-risk CAC (all ps < .05). Cumulative smoking exposure and cumulative depressive symptoms have a synergistic association with subclinical heart disease, where higher lifetime smoking exposure and depressive symptoms are associated with greater odds of CAC. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  5. Hepatitis C virus infection and risk of coronary artery disease

    DEFF Research Database (Denmark)

    Roed, Torsten; Lebech, Anne-Mette; Kjaer, Andreas

    2012-01-01

    Several chronic infections have been associated with cardiovascular diseases, including Chlamydia pneumoniae, human immunodeficiency virus and viral hepatitis. This review evaluates the literature on the association between chronic hepatitis C virus (HCV) infection and the risk of coronary artery...

  6. Angiographic prevalence and pattern of coronary artery disease in women

    Directory of Open Access Journals (Sweden)

    Babu Ezhumalai

    2014-07-01

    Conclusion: There has been a change with regard to clinical presentation and onset of risk factors for CAD at young age, but the load of atherosclerotic burden and pattern of involvement of coronary arteries have not changed in women.

  7. [Psychoprophylaxis in patients after coronary artery bypass graft operations].

    Science.gov (United States)

    Rymaszewska, Joanna; Chładzińska-Kiejna, Sylwia; Górna, Renata; Kustrzycki, Wojciech

    2004-05-01

    The paper presented problems of quality of life and psychosocial functioning of patients following coronary artery bypass grafting operations. Possibilities of psychoprophylactic effects towards these patients and its efficacy were described.

  8. Off-pump coronary artery bypass grafting or percutaneous transluminal coronary angioplasty with stenting for proximal left anterior descending coronary artery disease?

    NARCIS (Netherlands)

    Drenth, Derk Jan

    2005-01-01

    This thesis describes and discusses the results of a prospective randomized controlled clinical trial comparing percutaneous coronary angioplasty with stenting (stenting) and off-pump coronary artery bypass grafting with a left internal mammary artery (surgery) in patients with a high-grade stenosis

  9. Modern antiplatelet agents in coronary artery disease.

    LENUS (Irish Health Repository)

    Power, Rachel F

    2012-10-01

    Dual antiplatelet therapy is well recognized in the prevention of thrombotic complications of acute coronary syndrome and percutaneous coronary interventions. Despite clinical benefits of aspirin and clopidogrel therapy, a number of limitations curtail their efficacy: slow onset of action, variability in platelet inhibitory response and potential drug-drug interactions. Furthermore, the single platelet-activation pathway targeted by these agents allows continued platelet activation via other pathways, ensuring incomplete protection against ischemic events, thus, underscoring the need for alternate antiplatelet treatment strategies. A number of novel antiplatelet agents are currently in advance development and many have established superior effects on platelet inhibition, clinical outcomes and safety profile than clopidogrel in high-risk patients. The aim of this review is to provide an overview of the current status of P2Y12 receptor inhibition and PAR-1 antagonists in determining a future strategy for individualized antiplatelet therapy.

  10. Gene therapy and angiogenesis in patients with coronary artery disease

    DEFF Research Database (Denmark)

    Kastrup, Jens

    2010-01-01

    Not all patients with severe coronary artery disease can be treated satisfactorily with current recommended medications and revascularization techniques. Various vascular growth factors have the potential to induce angiogenesis in ischemic tissue. Clinical trials have only evaluated the effect...... of VEGF and FGF in patients with coronary artery disease. The initial small and unblinded studies with either recombinant growth factor proteins or genes encoding growth factors were encouraging, demonstrating both clinical improvement and evidence of angiogenesis. However, subsequent larger double...

  11. Spontaneous coronary artery dissection: complete angiographic resolution without stenting

    Directory of Open Access Journals (Sweden)

    Alexandre Abizaid

    2007-09-01

    Full Text Available A case of spontaneous coronary artery dissection in a 49-year-oldwoman is presented. She did not present the classical cardiovascular riskfactors. Etiology and treatment are discussed. She underwent primarypercutaneous coronary intervention of the left anterior descendingartery with no stenting and had complete angiographic resolution.

  12. Digital subtraction angiography (DSA) of the heart and coronary arteries

    International Nuclear Information System (INIS)

    Struyven, J.J.; Delcour, C.; Brion, J.P.; Vandenbosch, G.; Claessens, J.

    1986-01-01

    Digital subtraction angiography has potential advantages over conventional radiography. The removal of background structures makes possible to visualize chambers of the heart, great vessels and coronary arteries with a lower iodine signal than with conventional cineangiography. Digital data used for imaging can been manipulated for assessment and quantitation of the ventricular fonction and the coronary circulation

  13. Risk stratification of patients suspected of coronary artery disease

    DEFF Research Database (Denmark)

    Jensen, Jesper M; Voss, Mette; Hansen, Vibeke Bøgelund

    2012-01-01

    To compare the performance of five risk models (Diamond-Forrester, the updated Diamond-Forrester, Morise, Duke, and a new model designated COronary Risk SCORE (CORSCORE) in predicting significant coronary artery disease (CAD) in patients with chest pain suggestive of stable angina pectoris....

  14. Recurrent Syncope Attributed to Left Main Coronary Artery Severe Stenosis

    Directory of Open Access Journals (Sweden)

    Min Li

    2015-01-01

    Full Text Available Patients with acute coronary syndrome (ACS rarely manifest as recurrent syncope due to malignant ventricular arrhythmia. We report a case of a 56-year-old Chinese male with complaints of paroxysmal chest burning sensation and distress for 2 weeks as well as loss of consciousness for 3 days. The electrocardiogram (ECG revealed paroxysmal multimorphologic ventricular tachycardia during attack and normal heart rhythm during intervals. Coronary angiograph showed 90% stenosis in left main coronary artery and 80% stenosis in anterior descending artery. Two stents sized 4.0*18 mm and 2.75*18 mm were placed at left main coronary artery and anterior descending artery, respectively, during percutaneous coronary intervention (PCI. The patient was discharged and never had ventricular arrhythmia again during a 3-month follow-up since the PCI. This indicated that ventricular tachycardia was correlated with persistent severe myocardial ischemia. Coronary vasospasm was highly suspected to be the reason of the sudden attack and acute exacerbation. PCI is recommended in patients with both severe coronary artery stenosis and ventricular arrhythmia. Removing myocardial ischemia may stop or relieve ventricular arrhythmia and prevent cardiac arrest.

  15. The value of coronary artery calcium score assessed by dual-source computed tomography coronary angiography for predicting presence and severity of coronary artery disease

    International Nuclear Information System (INIS)

    Almasi, Alireza; Pouraliakbar, Hamidreza; Sedghian, Ahmad; Karimi, Mohammad Ali; Firouzi, Ata; Tehrai, Mahmood

    2014-01-01

    Measuring coronary artery calcium score (CACS) using a dual-source CT scanner is recognized as a major indicator for assessing coronary artery disease. The present study aimed to validate the clinical significance of CACS in predicting coronary artery stenosis and its severity. This prospective study was conducted on 202 consecutive patients who underwent both conventional coronary angiography and dual-source (256-slice) computed tomography coronary angiography (CTA) for any reason in our cardiac imaging center from March to September 2013. CACS was measured by Agatston algorithm on non-enhanced CT. The severity of coronary artery disease was assessed by Gensini score on conventional angiography. There was a significant relationship between the number of diseased coronary vessels and mean calcium score, i.e. the mean calcium score was 202.25±450.06 in normal coronary status, 427.50±607.24 in single-vessel disease, 590.03±511.34 in two-vessel disease, and 953.35±1023.45 in three-vessel disease (p<0.001). There was a positive association between calcium score and Gensini score (r=0.636, p<0.001). In a linear regression model, calcium score was a strong determinant of the severity of coronary artery disease. Calcium scoring had an acceptable value for discriminating coronary disease from normal condition with optimal cutoff point of 350, yielding a sensitivity and specificity of 83% and 70%, respectively. Our study confirmed the strong relationship between the coronary artery calcium score and the presence and severity of stenosis in coronary arteries assessed by both the number of diseased coronary vessels and also by the Gnesini score

  16. CORONARY ARTERY DISEASE IN INDIAN WOMEN

    Directory of Open Access Journals (Sweden)

    Mohammed Umar Farooque

    2017-05-01

    Full Text Available BACKGROUND Cardiovascular disease is the leading cause of death among women regardless of race or ethnicity accounting for deaths of 1 in 3 women. The aim of the study is to identify the important risk factors contributing to the coronary artery disease in Indian women. MATERIALS AND METHODS Study conducted on 120 women patients of age >40 yrs. visiting a female outpatient department of Jawahar Lal Nehru Medical College, Bhagalpur, who presented with complaints related to CAD cases diagnosed from the electrocardiogram findings, clinical features and biochemical marker as per World Health Organization guidelines. RESULTS 50-59 years age group is most effected group in study with 44.2%. Most of the women are of postmenopausal age group. The maximum number of cases was seen in upper lower socioeconomic status (37.5% followed by lower (19.2%. CAD incidence was minimum in upper class. Chest pain was the main complaint in patients, next in frequency was sweating and followed by breathlessness. The major risk factors in the study group were hypertension (74.1, diabetes (63.3, sedentary habits (49.1, stress (34.2, family history (29.2 and tobacco consumption (21.8. 25 patients had obesity and 54 peoples were overweight. In our study, 48 patients had 3 children, 19 had more than 3 children. 61.7% of the patients are with hypercholesterolaemia, which most of the patients found with 2 vessel block is most common blocks observed. CONCLUSION Despite this delay in onset, mortality from coronary heart disease is increasing more rapidly among women than men.

  17. The evaluation of atherosclerosis in coronary arteries with CT values

    International Nuclear Information System (INIS)

    Takemoto, Akiko

    1990-01-01

    In 50 patients with ischemic heart disease, X-ray computed tomography (CT) and coronary arteriography (CAG) were performed to compare CT values and CAG-proven stenosis in the left main trunk, left anterior descending, left circumflex, and right coronary artery. Luminal stenosis was graded as normal (no stenosis), minimal (between normal and significant), and significant (more than 50% in the left main trunk; more than 75% in the other arteries). CT values were significantly correlated with coronary artery stenosis; -5.4 in the normal group (71 arteries), +5.0 in the minimal group (63 arteries), and +31.8 in the significant group (51 arteries). In the normal group, CT values were independent of aging; -4.9 for patients younger than 50 years, -8.0 for those aged 50 to 59 years, and -0.4 for those more than 60 years. Increased CT values were associated with severer coronary artery disease shown on CAG. In determining significant coronary artery stenosis, CT values of more than 35 had a positive predictive value of 73.3%, a sensitivity of 43.1%, a specificity of 94.0%, an accuracy of 80.0%, and a likelihood ratio of 7.18. Measurement of CT values for the coronary arteries seems to be a noninvasive method for predicting significant stenosis. For patients younger than 60 years, high CT values even in a single artery seem to be associated with a high likelihood of significant stenosis and multivessel disease. (N.K.)

  18. Radial artery spasm occurred in transradial coronary intervention for coronary heart disease: its occurrence and predictors

    International Nuclear Information System (INIS)

    Zhong Jiming; Li Lang; Lu Yongguang; Zeng Shuyi

    2011-01-01

    Objective: To discuss the incidence and clinical predictors of radial artery spasm occurred in performing transradial coronary intervention for coronary heart disease. Methods: A total of 1020 patients, who underwent transradial coronary procedures for coronary heart disease during the period of May 2007 Jan 2010 in authors' hospital, were enrolled in this study. All clinical information and medication were recorded in detail. Arteriography via radial artery was performed in all patients. The diameter of the radial artery as well as the arterial anatomy, including arterial variations, were determined and observed, which was follow by coronary angiography or percutaneous coronary intervention. Multivariate Logistic regression analysis was adopted to evaluate the variables, such as clinical parameters, angiographic characteristics of the radial artery and procedure-related factors, in predicting the occurrence of radial artery spasm. Results: Radial artery spasm occurred in 209 (20.5%) patients. Multivariate Logistic regression analysis showed that the following eight factors were independently associated with the occurrence of radial artery spasm. These factors were as follows: female gender (OR=2.8, 95% CI 2.5-5.8; P=0.001), age (OR=0.68, 95% CI 0.60-0.92; P=0.003), smoking (OR=2.3, 95% CI 1.8-4.1; P=0.026), moderate-to-severe pain of forearm during radial artery cannulation (OR=3.0, 95% CI 2.3-4.8; P=0.006), radial artery anatomical abnormalities (OR=4.7, 95% CI 3.6-7.2; P=0.002), the ratio of radial artery diameter to patient's height (RAH) (OR=5.2, 95% CI 3.7-8.1; P=0.012), the ratio of radial artery diameter to outer diameter of the sheath (RAOD) (OR=5.8, 95% CI 4.2-6.9; P=0.006) and the number of catheter exchange (OR=2.3, 95% CI 1.4-4.3; P=0.038). Conclusion: Radial artery spasm occurred in performing transradial coronary intervention for coronary heart disease is frequently seen in clinical practice. Female gender, younger age, smoking, forearm pain during

  19. Coronary artery bypass grafts: assessment of graft patency and native coronary artery lesions using 16-slice MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Stauder, Norbert I.; Drosch, Tanja; Claussen, Claus D.; Kopp, Andreas F. [Eberhard-Karls-University, Department of Diagnostic Radiology, Tuebingen (Germany); Kuettner, Axel [Friedrich-Alexander-University, Department of Diagnostic Radiology, Erlangen (Germany); Schroeder, Stephen; Beck, Torsten [Eberhard-Karls-University, Department of Internal Medicine, Division Cardiology, Tuebingen (Germany); Stauder, Heidrun [Eberhard-Karls-University, Department of Thoracic and Cardiovascular Surgery, Tuebingen (Germany); Blumenstock, Gunnar [Eberhard-Karls-University, Department of Medical Information Processing, Tuebingen (Germany)

    2006-11-15

    The objective of this study was to evaluate the accuracy of electrocardiography (ECG)-gated 16-slice multidetector-row computed tomography (MDCT) in detection of stenosis of bypass grafts and native coronary arteries in patients who have undergone coronary artery bypass grafting (CABG). ECG-gated contrast-enhanced MDCT using 12 x 0.75-mm collimation was performed in 20 patients with recurrent angina 4.75 years after undergoing CABG. A total of 50 grafts, 16 arterial and 34 venous, were examined. All graft and coronary segments were evaluated for stenosis in comparison with conventional coronary angiography (CCA). Among the 80 arterial graft segments, 62 could be assessed (77.5%). Sensitivity, specificity, and positive and negative predictive values for stenosis were 96.2%, 97.2%, 96.2%, and 97.2%, respectively. In a total of 180 venous graft segments, 167 could be assessed. Sensitivity, specificity, and positive and negative predictive values for stenosis were 98.5%, 93.9%, 91.8%, and 98.9%, respectively. MDCT could assess 179 of 260 native coronary artery segments (68.8%).Sensitivity, specificity, and positive and negative predictive values for stenosis were 92.1%, 76.9%, 87.5%, and 84.7%, respectively. Sixteen-slice MDCT provides excellent image quality and diagnostic accuracy in detection of graft and coronary artery lesions in patients with suspected graft dysfunction. (orig.)

  20. Myocardial flow reserve is influenced by both coronary artery stenosis severity and coronary risk factors in patients with suspected coronary artery disease

    International Nuclear Information System (INIS)

    Tsukamoto, Takahiro; Naya, Masanao; Tsutsui, Hiroyuki; Morita, Koichi; Katoh, Chietsugu; Inubushi, Masayuki; Kuge, Yuji; Tamaki, Nagara

    2006-01-01

    Myocardial flow reserve (MFR) measurement has an important role in assessing the functional severity of coronary artery stenosis. However, a discrepancy between the anatomical severity of coronary artery stenosis and MFR is often observed. Such a discrepancy may be explained by coronary risk factors. In this study, we aimed to investigate the influence of coronary artery stenosis severity and risk factors on MFR. Seventy-four patients suspected to have coronary artery disease and seven age-matched healthy volunteers were enrolled. Myocardial blood flow (MBF) and MFR were measured using 15 O-labelled water PET. Regional MFR was calculated in regions with significant coronary artery stenosis (stenotic regions) and in regions without significant stenosis (remote regions). The contributions of coronary artery stenosis severity and coronary risk factors were assessed using univariate and multivariate analyses. In stenotic regions, MFR correlated inversely with coronary artery stenosis severity (r=-0.50, p<0.01). Univariate analysis did not show any significant difference in MFR between the patients with and the patients without each risk factor. In remote regions, however, MFR was significantly decreased in the diabetes and smoking groups (each p<0.05). By multivariate analysis, diabetes and smoking were independent predictors of MFR (each p<0.05). In the group with more than one risk factor, MFR was significantly lower (2.78±0.79) than in the other group (3.40±1.22, p<0.05). MFR is influenced not only by coronary stenosis severity but also by coronary risk factors. In particular, the influence of risk factors should be considered in regions without severe coronary stenosis. (orig.)

  1. Oral Health and Coronary Artery Disease, A Review Article

    Directory of Open Access Journals (Sweden)

    Alireza Rostami

    2016-03-01

    Full Text Available Atherosclerosis is the most common cause of myocardial infarction and ischemic stroke. Various risk factors have been identified for atherosclerosis. Recently, bacterial and viral organisms, which are involved in chronic inflammatory processes, have been also implicated in atherosclerosis development. Individuals with a prior history of periodontal diseases and/or tooth loss are considered to be at a higher risk for peripheral arterial disease, compared to those without periodontal diseases or tooth loss. Evidence suggests that periodontitis contributes to the overall burden of infection and inflammation and may lead to cardiovascular events and stroke in susceptible patients. In this article, we aimed to review the available data on the relationship between periodontal diseases and cardiovascular diseases, especially coronary artery disease. At least sixty papers were reviewed during 2014-15. Of these, 44 were included in our study.

  2. Psoriasis and ischemic coronary artery disease.

    Science.gov (United States)

    Mahiques-Santos, L; Soriano-Navarro, C J; Perez-Pastor, G; Tomas-Cabedo, G; Pitarch-Bort, G; Valcuende-Cavero, F

    2015-03-01

    Psoriasis is a chronic inflammatory disease associated with an increased risk of ischemic coronary artery disease (CAD) in some populations. We aimed to determine the association between these 2 diseases in our geographic area. We performed a cross-sectional study of patient records between 2005 and 2012 in the database (Abucacis, Datamart) that contains all medical case histories in the province of Castellón, Spain. Patients diagnosed with psoriasis were compared with a control group of patients diagnosed with melanocytic nevus. The prevalence of CAD and the presence or absence of the main cardiovascular risk factors were analyzed in each group. A total of 9181 patients with psoriasis and 21925 with melanocytic nevus were studied. Univariate logistic regression analysis showed that CAD was significantly associated with psoriasis, age (in years), sex, hypertension, diabetes mellitus, dyslipidemia, and obesity (P<.05). On adjustment for age, sex, and the other cardiovascular risk factors, multivariate regression analysis established that psoriasis was independently associated with CAD (P<.029). Our findings in a large sample of patients in a Mediterranean area support the hypothesis that patients in this population have an increased risk of ischemic CAD. Copyright © 2014 Elsevier España, S.L.U. and AEDV. All rights reserved.

  3. Stress myocardial scintigraphy in coronary artery disease

    International Nuclear Information System (INIS)

    Hata, Noritake; Koumi, Shin-ichi; Yasutake, Masahiro; Imaizumi, Takahiro; Saito, Tsutomu; Kishida, Hiroshi; Hayakawa, Hirokazu

    1991-01-01

    To evaluate the clinical significance of asymptomatic ischemic heart disease, exercise electrocardiography and stress myocardial scintigraphy were performed. These were correlated with symptoms during exercise tests and histories of myocardial infarction (MI). The study subjects consisted of 70 patients with coronary artery disease, including 34 with MI, and 36 without MI but with angina pectoris. Stress tests were performed using bicycle ergometer under electrocardiographic monitoring throughout the test. Transient myocardial ischemia was confirmed by perfusion defects on thallium myocardial imaging demonstrated immediately after exercise, but not 3 hours after the stress test. Asymptomatic ST depression was observed in 18 of 34 patients with MI (53%) and in 21 of the 36 patients with angina (58%); however, transient myocardial perfusion defects were confimred in 61% of the patients with MI (11 of 18 patients), but in only 33% of those with angina (7 of 21 patients). The difference was statistically significant (p<0.05). It was suggested that there are some differences in the clinical significance of asymptomatic ST depression between the patients with MI and those without MI but with angina pectoris. (author)

  4. Natriuretic peptides in unstable coronary artery disease.

    Science.gov (United States)

    Jernberg, Tomas; James, Stefan; Lindahl, Bertil; Johnston, Nina; Stridsberg, Mats; Venge, Per; Wallentin, Lars

    2004-09-01

    Patients with unstable coronary artery disease (CAD), i.e., unstable angina or non-ST-elevation myocardial infarction, vary widely in clinical presentation, prognosis and response to treatment. To select appropriate therapy, early risk stratification has become increasingly important. This review focuses on the emerging role of natriuretic peptides in the early assessment of patients with unstable CAD. We conclude that levels of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are strongly associated to mortality and the risk of future congestive heart failure, and carry important prognostic information independent from previously known risk factors in unstable CAD. There are some data indicating that these markers can also be helpful in the selection of appropriate therapy in these patients but further studies are needed. Before a routine use of BNP or NT-proBNP in unstable CAD can be recommended, the cost-effectiveness of adding these new markers to the currently routine markers and their impact on selection of treatment needs further evaluation. Copyright 2004 Elsevier Ltd

  5. Spontaneous coronary artery dissection causing acute coronary syndrome in a young patient without risk factors

    Directory of Open Access Journals (Sweden)

    Parag Chevli

    2014-09-01

    Full Text Available Spontaneous coronary artery dissection (SCAD is a rare cause of acute myocardial infarction that is more common in younger patients (under age 50 and in women. Although the etiology is not known, some predisposing conditions to SCAD are well known and include Marfan syndrome, pregnancy and peripartum state, drug abuse, and some anatomical abnormalities of the coronary arteries such as aneurysms and severe kinking. We describe a case of SCAD in a young woman who presented with sudden onset of chest pain and was admitted for the treatment of acute coronary syndrome. The coronary angiography showed dissection of the left anterior descending artery. The patient underwent successful percutaneous transluminal coronary angioplasty and stent placement.

  6. The association of opium with coronary artery disease.

    Science.gov (United States)

    Sadeghian, Saeed; Darvish, Soodabeh; Davoodi, Gholamreza; Salarifar, Mojtaba; Mahmoodian, Mehran; Fallah, Nader; Karimi, Abbas Ali

    2007-10-01

    The effects of opium consumption on coronary artery disease are still unknown. A cross-sectional study was conducted on 2405 patients admitted to the Angiographic Ward at Tehran Heart Center from 7 May 2005 to 13 August 2005. After adjusting for conventional cardiovascular risk factors, opium consumption was a significant risk factor for coronary artery disease (P=0.01 and odds ratio=1.8). Moreover, the amount of opium consumption was associated significantly with the severity of coronary atherosclerosis, as measured by clinical vessel score (r=0.2, P=0.002). To our knowledge, this is the first time that the adverse effects of opium consumption on coronary arteries was defined.

  7. Radiologic evaluation of coronary artery fistula in adult

    International Nuclear Information System (INIS)

    Je, Eun Kyoung; Kim, Yang Min; Choi, Ik Joon; Kim, Seong Bae; Lee, Jae Young; Han, Sang Wook; Cho, Sung Hwui; Park, Jae Hyung; Choi, Yonug Hi

    1997-01-01

    To evaluate the clinical and radiologic findings of coronary artery fistula (CAF) by reviwing adult patients in whom this condition had been diagnosed by coronary angiogram. We retrospectively analysed the clinical findings, chest X-rays and angiographic findings of 37 adult CAF patients treated at three institutes over a period of is 15 years. On coronary angiogram, the origin of CAF was found to be the left coronary artery (LCA) in 20 cases(54%), the right coronary artery (RCA) in five (14%), and both in 12(32%). By subdividing the coronary artery into four segments [RCA, left main coronary artery, left anterior descending artery(LAD), and left circumflex artery(LCX)], the origin of CAF (total 55 cases) was found to be the LAD in 23 cases(42%), the LCX in 12(22%), the left main coronary artery in three (5%), and the RCA in 17(31%). The draining site of CAF was the right heart [right atrium, right ventricle, and main pulmonary artery(MPA)] in 28 cases(75%) the left heart(left atrium and left ventricle) in 8(22%), and both in one (3%). The fistula drained to the cardiac chamber in 12 cases (33%), the MPA in 23(62%), and both in 2(5%). Among 55 cases, the total number of fistulas to the MPA was 35, and their origin was the RCA in nine instances (26%), and the left coronary artery in 26(74%). CAF to the MPA was classified into four types:Type I(single, tortuous and not dilated) was seen in six patients (17%), type II(single, tortuous and dilated) in three (9%), type III(multiple and fine plexus) in 21(60%), and type IV(multiple and dilated plexus)in five (14%). Eighteen cases (49%) were associated with the other cardiac disease. In these Korean adults, CAF originated most commonly from the LCA, especially from the LAD segment of this artery, and most frequently drained to the right cardic chamber, especially to the MPA. The morphology of the CAF to the MPA was mostly multiple and fine plexus. We suggest that to ensure the most suitable treatment, and for better

  8. High-resolution coronary MR angiography for evaluation of patients with anomalous coronary arteries: visualization of the intramural segment

    Energy Technology Data Exchange (ETDEWEB)

    Biko, David M. [UCSF Benioff Children' s Hospital Oakland, Department of Diagnostic Imaging, Oakland, CA (United States); The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Chung, Claudia; Chung, Taylor [UCSF Benioff Children' s Hospital Oakland, Department of Diagnostic Imaging, Oakland, CA (United States); Hitt, David M. [Philips Healthcare, Cleveland, OH (United States); Kurio, Gregory [UCSF Benioff Children' s Hospital Oakland, Department of Cardiology, Oakland, CA (United States); Reinhartz, Olaf [UCSF Benioff Children' s Hospital Oakland, Department of Cardiac Surgery, Oakland, CA (United States)

    2015-08-15

    Anomalous origin of the coronary artery from the contralateral coronary sinus is a rare coronary anomaly associated with sudden death. The inter-arterial course is most closely associated with sudden death, but it has been suggested that the presence of an intramural segment of a right anomalous coronary is associated with more symptoms and therefore may be an important criterion for intervention in these patients. To demonstrate that MR angiography can accurately determine the presence or absence of an intramural segment in an anomalous coronary artery. All studies of children who underwent MR angiography for the evaluation of an anomalous coronary artery were retrospectively reviewed by two pediatric radiologists in consensus. Criteria for an intramural anomalous coronary artery were the presence of a small or slit-like ostium and the relative smaller size of the proximal intramural portion of the coronary artery in relation to the more distal epicardial coronary artery. The anomalous coronary artery was classified as not intramural if these two findings were absent. These findings were correlated with operative reports confirming the presence or absence of an intramural segment. Twelve patients (86%) met MR angiography criteria for the presence of an intramural course. Only 2 patients (14%) met MR angiography criteria for a non-intramural course. When correlating with intraoperative findings, MR angiography was successful in distinguishing between intramural and non-intramural anomalous coronary arteries in all cases (P = 0.01). MR angiography may be able to reliably identify the intramural segment of an anomalous coronary artery in older children using the imaging criteria of a small or slit-like ostium and relative decrease in size of the proximal portion of the anomalous coronary artery compared to the distal portion of the anomalous coronary artery. Determining the presence of the intramural segment may help with surgical planning and may be an important

  9. Non-obstructive coronary artery disease assessed by coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Nielsen, L.; Bøtker, H. E.; Sorensen, H.

    2015-01-01

    Introduction: Coronary CT angiography (CTA) detects non-obstructive coronary artery disease (CAD) that may not be recognized by functional testing, but the prognostic impact is not well understood. This study aimed to compare the risk of myocardial infarction (MI) and all-cause mortality...... in patients without or with non-obstructive and obstructive CAD assessed by coronary CTA. Methods: Consecutive patients without known coronary artery disease (CAD) and with chest pain who underwent coronary CTA (>64-detector row) between January 2007 and December 2012 in the 10 centers participating...... in the Western Denmark Cardiac Computed Tomography Registry were included. The endpoints were 3-year MI or all-cause mortality. The coronary CTA result was defined as normal (0% luminal stenosis), non-obstructive CAD (1%-49% luminal stenosis) or obstructive CAD (>50% luminal stenosis; 1-vessel, 2-vessel, or 3...

  10. The cristal (right superior septal) coronary artery and its relationship to anomalous left coronary origin

    International Nuclear Information System (INIS)

    Partridge, J.B.; Ridley, L.J.

    2011-01-01

    The cristal artery is an occasional finding, being visible in around 3% of coronary angiograms, arising from the proximal right coronary artery (RCA) and passing downwards and forwards through the muscle of the crista superventricularis. It supplies a variable volume of the superior interventricular septum, and can contribute to collateralization of the other septal vessels. When part or all of the left coronary artery (LCA) arises anomalously from the right coronary sinus, its passage to the left may be in the same pathway as a cristal artery, bearing a tell-tale septal vessel arising from its proximal segment. This helps to differentiate it from one that has a higher pathway, running between the great vessels, and which may have a greater correlation with sudden cardiac death.

  11. Compensatory enlargement of the left main coronary artery: insights from the PROSPECT study.

    Science.gov (United States)

    Inaba, Shinji; Mintz, Gary S; Shimizu, Takehisa; Weisz, Giora; Mehran, Roxana; Marso, Steven P; Xu, Ke; de Bruyne, Bernard; Serruys, Patrick W; Stone, Gregg W; Maehara, Akiko

    2014-03-01

    Glagov proposed that remodeling delayed development of significant coronary artery stenoses until plaque occupied, on average, 40% of arterial area (40% plaque burden). The aim of the current study was to confirm the previously proposed concept of coronary remodeling as first described by Glagov who studied postmortem left main coronary arteries (LMCAs). Using the in-vivo intravascular ultrasound data from the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study, we evaluated 552 LMCAs in 552 patients. External elastic membrane cross-sectional areas (CSAs) increased in proportion to the increase in plaque and media CSAs (r=0.61, P40% plaque burden), there was an inverse relationship between lumen CSA and plaque burden (r=-0.57, PPROSPECT study patients. In addition, the present study suggested that plaque phenotype worsened with increasing LMCA plaque growth.

  12. Self-expanding intracoronary stents in the treatment of coronary artery disease: new developments and future directions

    NARCIS (Netherlands)

    Lu, H.; Grundeken, M. J.; Koch, K. T.; Wykrzykowska, J. J.

    2013-01-01

    The first stent implanted in the human coronary circulation was a self-expandable (SE) stent and was introduced almost simultaneously with the first balloon-expandable (BE) stents in the late 1980s. Nowadays, the majority of the available stents are delivered by balloon expansion. While BE stents

  13. Trends in Percutaneous Coronary Intervention and Coronary Artery Bypass Surgery in Korea

    Directory of Open Access Journals (Sweden)

    Heeyoung Lee

    2016-12-01

    Full Text Available Background: Coronary angioplasty has been replacing coronary artery bypass grafting (CABG because of the relative advantage in terms of recovery time and noninvasiveness of the procedure. Compared to other Organization for Economic Cooperation and Development (OECD countries, Korea has experienced a rapid increase in coronary angioplasty volumes. Methods: We analyzed changes in procedure volumes of CABG and of percutaneous coronary intervention (PCI from three sources: the OECD Health Data, the National Health Insurance Service (NHIS surgery statistics, and the National Health Insurance claims data. Results: We found the ratio of procedure volume of PCI to that of CABG per 100,000 population was 19.12 in 2014, which was more than triple the OECD average of 5.92 for the same year. According to data from NHIS statistics, this ratio was an increase from 11.4 to 19.3 between 2006 and 2013. Conclusion: We found that Korea has a higher ratio of total procedure volumes of PCI with respect to CABG and also a more rapid increase of volumes of PCI than other countries. Prospective studies are required to determine whether this increase in absolute volumes of PCI is a natural response to a real medical need or representative of medical overuse.

  14. Association of ischemic stroke to coronary artery disease using computed tomography coronary angiography

    DEFF Research Database (Denmark)

    Jensen, Jesper Møller; Medina, Hector; Nørgaard, Bjarne Linde

    2012-01-01

    BACKGROUND: While patients with coronary artery disease (CAD) and cerebrovascular disease share similar risk factor profiles, data on whether IS can be considered a "CAD equivalent" are limited. We aimed to determine whether ischemic stroke is an independent predictor of CAD by using cardiac...... increase odds of having coronary artery plaque (odds ratio [OR] 4.9, P4 segments of plaque than 0-4 segments as compared to patients without stroke (OR 18.3, P...

  15. Coronary 64-slice CT angiography predicts outcome in patients with known or suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Gaemperli, Oliver; Valenta, Ines; Schepis, Tiziano [University Hospital Zurich NUK C 32, Cardiovascular Center, Zurich (Switzerland); Husmann, Lars; Scheffel, Hans; Desbiolles, Lotus; Leschka, Sebastian; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich NUK C 32, Cardiovascular Center, Zurich (Switzerland); University of Zurich, Zurich Center for Integrative Human Physiology (ZIHP), Zurich (Switzerland)

    2008-06-15

    The aim of this study was to assess the prognostic value of 64-slice CT angiography (CTA) in patients with known or suspected coronary artery disease (CAD). Sixty-four-slice coronary CTA was performed in 220 patients [mean age 63 {+-} 11 years, 77 (35%) female] with known or suspected CAD. CTA images were analyzed with regard to the presence and number of coronary lesions. Patients were followed-up for the occurrence of the following clinical endpoints: death, nonfatal myocardial infarction, unstable angina, and coronary revascularization. During a mean follow-up of 14 {+-} 4 months, 59 patients (27%) reached at least one of the predefined clinical endpoints. Patients with abnormal coronary arteries on CTA (i.e., presence of coronary plaques) had a 1st-year event rate of 34%, whereas in patients with normal coronary arteries no events occurred (event rate, 0%, p < 0.001). Similarly, obstructive lesions ({>=}50% luminal narrowing) on CTA were associated with a high first-year event rate (59%) compared to patients without stenoses (3%, p < 0.001). The presence of obstructive lesions was a significant independent predictor of an adverse cardiac outcome. Sixty-four-slice CTA predicts cardiac events in patients with known or suspected CAD. Conversely, patients with normal coronary arteries on CTA have an excellent mid-term prognosis. (orig.)

  16. Drug therapy or coronary angioplasty for the treatment of coronary artery disease : New insights

    NARCIS (Netherlands)

    Amoroso, G; Van Boven, AJ; Crijns, HJGM

    Background In the last decade percutaneous transluminal coronary angioplasty has become a very popular strategy For the treatment of coronary artery disease, although its efficacy in reducing ischemic events and the subsequent need for revascularization has yet to be proved. Methods We reviewed the

  17. Classification of coronary artery tissues using optical coherence tomography imaging in Kawasaki disease

    Science.gov (United States)

    Abdolmanafi, Atefeh; Prasad, Arpan Suravi; Duong, Luc; Dahdah, Nagib

    2016-03-01

    Intravascular imaging modalities, such as Optical Coherence Tomography (OCT) allow nowadays improving diagnosis, treatment, follow-up, and even prevention of coronary artery disease in the adult. OCT has been recently used in children following Kawasaki disease (KD), the most prevalent acquired coronary artery disease during childhood with devastating complications. The assessment of coronary artery layers with OCT and early detection of coronary sequelae secondary to KD is a promising tool for preventing myocardial infarction in this population. More importantly, OCT is promising for tissue quantification of the inner vessel wall, including neo intima luminal myofibroblast proliferation, calcification, and fibrous scar deposits. The goal of this study is to classify the coronary artery layers of OCT imaging obtained from a series of KD patients. Our approach is focused on developing a robust Random Forest classifier built on the idea of randomly selecting a subset of features at each node and based on second- and higher-order statistical texture analysis which estimates the gray-level spatial distribution of images by specifying the local features of each pixel and extracting the statistics from their distribution. The average classification accuracy for intima and media are 76.36% and 73.72% respectively. Random forest classifier with texture analysis promises for classification of coronary artery tissue.

  18. Dual-artery stenting of a type III single coronary artery from right aortic sinus

    Directory of Open Access Journals (Sweden)

    Shivanad Patil

    2015-12-01

    Full Text Available A single coronary artery presenting with stenosis in two of the three vessels arising from a common ostium is a rare anomaly Lipton et al. proposed a classification, which was modified by Yamanaka and Hobbs. In our case, a single coronary artery was giving rise to the LAD, left circumflex (LCx, and the right coronary artery (RCA. There was 80% stenosis in the ostium of the LCx. The RCA in the mid and distal segment had stenosis of 80% and 70%, respectively. We were able to successfully stent the three stenotic segments.

  19. Congenital coronary artery anomalies: a bridge from embryology to anatomy and pathophysiology—a position statement of the development, anatomy, and pathology ESC Working Group

    Czech Academy of Sciences Publication Activity Database

    Pérez-Pomares, J. M.; de la Pompa, J. L.; Franco, D.; Henderson, D.; Ho, S. Y.; Houyel, L.; Kelly, R. G.; Sedmera, David; Sheppard, M.; Sperling, S.; Thiene, G.; van den Hoff, M.; Basso, C.

    2016-01-01

    Roč. 109, č. 2 (2016), s. 204-216 ISSN 0008-6363 R&D Projects: GA ČR(CZ) GAP302/11/1308; GA ČR(CZ) GA13-12412S Institutional support: RVO:67985823 Keywords : coronary arteries * embryology * congenital heart disease * pathology * anatomy Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 5.878, year: 2016

  20. Frequency and predictors of renal artery stenosis in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Shah, S.S.; Hafeezullah, M.

    2010-01-01

    Background: Renal artery stenosis (RAS) is a common finding in patients undergoing coronary angiography. We designed this study to look for the frequency and any predictors of renal artery stenosis in patients with coronary artery disease (CAD). Methods: A total of 201 consecutive patients with CAD confirmed by coronary angiography underwent an abdominal aortogram in the same sitting to screen for RAS. Patient demographics and co-morbidities were analysed for any association with RAS. Results: Forty-one of the patients were female (20.4%); ninety patients were hypertensive (44.8%); 49 patients (24.4%) were smokers; 19 patients (9.5%) had renal insufficiency; 88 patients (43.8%) had high cholesterol levels; 44 patients (21.9%) were diabetic. Thirty-two patients (15.9%) had single coronary artery disease, 59 patients (29.4%) had two vessel disease, and 110 patients (54.7%) had three vessel disease. Significant renal artery stenosis (less or equal to 50% stenosis) was present in 26 patients (12.9%). Among the variables studied, only female gender was found to be associated with a higher frequency of renal artery stenosis (24.39% vs 10.0%, p=0.01). Conclusions: The frequency of renal artery stenosis in patients with coronary artery disease is 12.9%. Female gender is associated with a higher frequency of renal artery stenosis in patients with CAD. (author)

  1. Lifestyle-related factors, obesity, and incident microalbuminuria: the CARDIA (Coronary Artery Risk Development in Young Adults) study.

    Science.gov (United States)

    Chang, Alex; Van Horn, Linda; Jacobs, David R; Liu, Kiang; Muntner, Paul; Newsome, Britt; Shoham, David A; Durazo-Arvizu, Ramon; Bibbins-Domingo, Kirsten; Reis, Jared; Kramer, Holly

    2013-08-01

    Modifiable lifestyle-related factors are associated with risk of coronary heart disease and may also influence kidney disease risk. Community-based prospective cohort study. 2,354 African American and white participants aged 28-40 years without baseline microalbuminuria or estimated glomerular filtration rate food habits, obesity, and diet quality, which was based on 8 fundamental components of the Dietary Approaches to Stop Hypertension (DASH) diet, including increased intake of fruits, vegetables, low-fat dairy products, whole grains, and nuts and legumes and reduced intake of sodium, sugar-sweetened beverages, and red and processed meats. Spot urine albumin-creatinine ratios were obtained at baseline (1995-1996) and three 5-year follow-up examinations (5, 10, and 15 years' follow-up). Incident microalbuminuria was defined as the presence of age- and sex-adjusted albumin-creatinine ratio ≥25 mg/g at 2 or more of the successive follow-up examinations. During the 15-year follow-up, 77 (3.3%) individuals developed incident microalbuminuria. After multivariable adjustment, poor diet quality (OR, 2.0; 95% CI, 1.1-3.4) and obesity (OR, 1.9; 95% CI, 1.1-3.3) were associated significantly with microalbuminuria; current smoking (OR, 1.6; 95% CI, 0.9-2.8) was associated with microalbuminuria, although the CI crossed 1.0. Neither low physical activity (OR, 1.0; 95% CI, 0.5-1.8) nor fast food consumption (OR, 1.2; 95% CI, 0.7-2.3) was associated with microalbuminuria. Compared with individuals with no unhealthy lifestyle-related factors (poor diet quality, current smoking, and obesity), adjusted odds of incident microalbuminuria were 131%, 273%, and 634% higher for the presence of 1 (OR, 2.3; 95% CI, 1.3-4.3), 2 (OR, 3.7; 95% CI, 1.8-7.7), and 3 (OR, 7.3; 95% CI, 2.1-26.1) unhealthy lifestyle-related factors. Self-reported dietary history and physical activity, low number of outcomes. Consuming an unhealthy diet and obesity are associated with incident microalbuminuria

  2. Simultaneous nephrectomy and coronary artery bypass grafting through extended sternotomy

    Directory of Open Access Journals (Sweden)

    Budrikis Algimantas

    2012-08-01

    Full Text Available Abstract Background The advances in surgical techniques, resuscitation and anesthesiology support over the last years have allowed simultaneous thoracic and abdominal operations to be made for cancer and concomitant severe heart vessel disease relieving the patient from several diseases simultaneously and achieving long lasting remission or cure. Clinical case A simultaneous nephrectomy and coronary artery bypass grafting procedure through extended sternotomy is reported. A 63-year-old man with severe coronary artery disease was found to have renal carcinoma. Diagnosis Postoperative pathological investigation of the tumor revealed the presence of renal cell carcinoma pT3a N0 M0, G2. Coronarography revealed advanced three-vessel coronary artery disease. Treatment We successfully performed a simultaneous curative surgery for renal carcinoma and coronary artery bypass graft surgery under cardiopulmonary bypass using a novel technique of extended sternotomy. Simultaneous surgery thus appears to be a beneficial and safe approach for the treatment of coronary artery disease and resectable renal cancer in carefully selected patients.

  3. [Coronary subclavian steal syndrome: two cases after coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Penninga, L.; Damgaard, S.

    2008-01-01

    Reverse flow in the internal mammary artery (IMA) graft due to stenosis or occlusion of the proximal ipsilateral subclavian artery causes coronary subclavian steal syndrome (CSSS). We describe two patients who were diagnosed with CSSS following CABG. Patient A presented with angina pectoris...

  4. Carotid disease in diabetic patients undergoing coronary artery bypass grafting

    International Nuclear Information System (INIS)

    Shahid, M.; Abid, A.R.; Dar, M.A.; Noeman, A.; Amin, S.; Azhar, M.

    2012-01-01

    Objective: To compare the severity of carotid artery disease in diabetic and non-diabetic patients undergoing coronary artery bypass grafting. Methods: From January to June 2008, 379 patients undergoing elective coronary artery bypass surgery were preoperatively evaluated for the presence of carotid stenoses by duplex scanning. Patients were divided into two groups, Group I, 156 (41.2%) diabetic patients and Group II, 223 (58.8%) non-diabetic patients. Results: There were 314 (82.8%) males and 65 (17.2%) females with a mean age of 57.2+-9.1 years. In diabetic group there were 125 (80.1%) males and 31 (19.9%) females with a mean age of 56.3+-8.9 years. Left main stem stenosis was present in 59 (37.8%) diabetics and 45 (20.2%) non-diabetics (p 70% stenosis was present in 20 (5.3%) with 13 (8.3%) diabetics and 7 (3.1%) non-diabetics (p<0.025). Stenosis of 50-70% was observed in 30 (7.9%) of which 17 (10.9%) were diabetics and 13 (5.8%) were non-diabetics. Conclusion: Presence of diabetes mellitus is associated with diffuse coronary artery disease and significant carotid artery disease in patients undergoing coronary artery bypass grafting. (author)

  5. Increased expression of endothelin ET(B) and angiotensin AT(1) receptors in peripheral resistance arteries of patients with suspected acute coronary syndrome

    DEFF Research Database (Denmark)

    Dimitrijevic, Ivan; Ekelund, Ulf; Edvinsson, Lars

    2009-01-01

    of arterial vasoconstrictor endothelin (ET) and angiotensin (AT) receptors. Our aim was to investigate if the arterial expressions of these receptors are changed in patients with suspected but ruled out acute coronary syndrome (ACS). Small subcutaneous arteries (diameter of 100 microm) were surgically removed...... in the regulation of coronary tone and in the development of atherosclerosis, and may be related to increased cardiovascular risk....

  6. Multiple Culprit Coronary Artery Thrombosis in a Patient with Coronary Ectasia

    Directory of Open Access Journals (Sweden)

    Bruno da Silva Matte

    2018-01-01

    Full Text Available We here report a case of ST-elevation myocardial infarction (STEMI due to simultaneous acute coronary artery occlusions of two major coronary arteries in a patient with coronary ectasia. The patient had been previously submitted to percutaneous coronary angioplasty with bare metal stent implantation in both culprit vessels. Very late stent thrombosis could be the cause of the first occlusion, triggering the event in the other vessel. In addition, concomitant embolic sources were not identified. Although routine aspiration thrombectomy in STEMI was not proven to be beneficial in randomized clinical trials, it was of great value in this case. We also discuss the relation between coronary ectasia, chronic inflammatory status, and increased platelet activity which may have caused plaque disruption in another already vulnerable vessel.

  7. Evaluation of Coronary Artery Stenosis by Quantitative Flow Ratio During Invasive Coronary Angiography

    DEFF Research Database (Denmark)

    Westra, Jelmer; Tu, Shengxian; Winther, Simon

    2018-01-01

    BACKGROUND: Quantitative flow ratio (QFR) is a novel diagnostic modality for functional testing of coronary artery stenosis without the use of pressure wires and induction of hyperemia. QFR is based on computation of standard invasive coronary angiographic imaging. The purpose of WIFI II (Wire...... patients with suspected coronary artery disease on coronary computed tomographic angiography for diagnostic invasive coronary angiography. Fractional flow reserve (FFR) was measured in all segments with 30% to 90% diameter stenosis. Blinded observers calculated QFR (Medis Medical Imaging bv......, The Netherlands) for comparison with FFR. FFR was measured in 292 lesions from 191 patients. Ten (5%) and 9 patients (5%) were excluded because of FFR and angiographic core laboratory criteria, respectively. QFR was successfully computed in 240 out of 255 lesions (94%) with a mean diameter stenosis of 50...

  8. Heart and coronary artery damage related to Kawasaki syndrome

    Directory of Open Access Journals (Sweden)

    A. A. Leontyeva

    2014-01-01

    Full Text Available Kawasaki syndrome is an acute systemic vasculitis of unknown etiology, which mainly affects children within the first 5 years of fife. At the present time, Kawasaki syndrome is recognized to be a leading cause of acquired organic heart diseases in children, which may result in coronary heart disease, myocardial infarction, and sudden death in children and young people. Most complications are associated with the cardiovascular system, with coronary artery changes in particular. Transthoracic echocardiography, which, besides coronary artery assessment, makes it possible to evaluate right and left ventricular systolic and diastolic functions and to study the cardiac valves and changes in pericardial effusion, is a major technique in Kawasaki syndrome. The paper outlines an update on the epidemiology, etiology, pathogenetic mechanisms, and pathomorphology of Kawasaki syndrome and considers possible coronary and noncoronary changes, outcomes, and clinical manifestations.

  9. Specific perfusion pattern in stress 201Tl myocardial scintigraphy of left main coronary artery disease

    International Nuclear Information System (INIS)

    Wakasugi, Shigetoshi; Shibata, Nobuhiko; Kobayashi, Tohru; Fudemoto, Yoshiyuki; Hasegawa, Yoshihisa; Nakano, Shunichi

    1986-01-01

    The usefulness of stress 201 Tl myocardial scintigraphy for identifying left main coronary artery disease was evaluated with data from 23 patients with 50% or more narrowing of the left main coronary artery and 56 patients with 75% or more narrowing of the major coronary arteries but without left main coronary artery involvement (no left main coronary artery disease). Quantitative evaluation of stress perfusion scintigrams in all five patients with narrowing of the left main coronary artery of 90% or more showed a characteristic perfusion pattern (left main pattern) of extensive homogeneous defect over the whole anterolateral segment and simultaneous defects in all radii of the high anteroseptal and high posterolateral segments. On the other hand, such a perfusion pattern was noted in only 1 of 18 patients with less than 90% stenosis of the left main coronary artery and in only 1 of 56 patients with no left coronary artery disease. (orig.)

  10. Multislice CT coronary angiography: effect of sublingual nitroglycerine on the diameter of coronary arteries

    International Nuclear Information System (INIS)

    Dewey, M.; Hamm, B.; Hoffmann, H.

    2006-01-01

    Purpose: to investigate the influence of sublingual glycerol trinitrate (1.2 mg, Nitrate [nitroglycerine], Nitrolingual N spray) on the coronary artery diameter on multislice computed tomography (MSCT) coronary angiography. Materials and methods: out of our database of patients who underwent MSCT (slice thickness of 0.5 mm, Aquilion, Toshiba) coronary angiography between July 2003 and November 2005 (950 patients) we retrospectively identified patients with follow-up examinations who received Nitrate for one examination while another examination was performed without Nitrate (10 patients). Another 10 patients who underwent two MSCT examinations with sublingual Nitrate administration were randomly selected from this database to serve as control group. For the resulting 40 MSCT examinations, blinded MSCT datasets were prepared, which were randomly evaluated by a reader blinded to the patient information and whether or not Nitrate had been given. The proximal coronary artery diameters were measured for the left main coronary artery (LMA), the left anterior descending coronary artery (LAD), the left circumflex coronary artery (LCX), and the right coronary artery (RCA) in all 40 datasets, resulting in altogether 160 measurements. Results: the proximal diameters of all four coronary arteries were significantly larger on the MSCT coronary angiograms obtained after sublingual administration of Nitrate compared with the examinations in the same 10 patients without Nitrate (p < 0.001). The average diameters without and with Nitrate for the LMA, LAD, LCX, and RCA were 4.3 ± 1.1 vs. 4.8 ± 0.9 mm (12% increase, p < 0.005), 3.0 ± 0.6 vs. 3.5 ± 0.5 mm (17% increase, p < 0.001), 2.7 ± 0.6 vs. 3.2 ± 0.7 mm (19% increase, p < 0.005), and 2.9 ± 0.9 vs. 3.5 ± 0.7 mm (21% increase, p < 0.005), respectively. In the control group of 10 patients who underwent two MSCT coronary angiographies after sublingual Nitrate, no significant difference in the proximal diameter of all four

  11. Racial Differences in Abnormal Ambulatory Blood Pressure Monitoring Measures: Results From the Coronary Artery Risk Development in Young Adults (CARDIA) Study

    Science.gov (United States)

    Lewis, Cora E.; Diaz, Keith M.; Carson, April P.; Kim, Yongin; Calhoun, David; Yano, Yuichiro; Viera, Anthony J.; Shimbo, Daichi

    2015-01-01

    BACKGROUND Several ambulatory blood pressure monitoring (ABPM) measures have been associated with increased cardiovascular disease risk independent of clinic blood pressure (BP). African Americans have higher clinic BP compared with Whites but few data are available on racial differences in ABPM measures. METHODS We compared ABPM measures between African American (n = 178) and White (n = 103) participants at the Year 5 Coronary Artery Risk Development in Young Adults study visit. BP was measured during a study visit and the second and third measurements were averaged. ABPM was conducted over the following 24 hours. RESULTS Mean ± SD age of participants was 29.8±3.8 years and 30.8±3.5 years for African Americans and Whites, respectively. Mean daytime systolic BP (SBP) was 3.90 (SD 1.18) mm Hg higher among African Americans compared with Whites (P ABPM was higher among African Americans compared with Whites. CONCLUSIONS These data suggest racial differences in several ABPM measures exist. PMID:25376639

  12. The quality of life of patients developed delirium after coronary artery bypass grafting is determined by cognitive function after discharge: A cross-sectional study.

    Science.gov (United States)

    Chen, Yuling; Ding, Shu; Tao, Xiangjun; Feng, Xinwei; Lu, Sai; Shen, Yuzhi; Wu, Ying; An, Xiangguang

    2017-10-01

    Postoperative delirium (POD) and declined cognitive function were common in patients (especially elderly patients) who underwent coronary artery bypass grafting (CABG), which may affect quality of life (QoL). The aim of this study was to determine the relationships among age, POD, declined cognitive function, and QoL in patients who underwent CABG. Consecutive patients who underwent first time elective CABG and assessed for POD using Confusion Assessment Method for intensive care unit for 5 postoperative days from November 2013 to March 2015 were recruited. A cross-sectional study was conducted during April 2015 to assess their cognitive function and QoL, using the Telephone Interview for Cognitive Status Scale and Medical Outcomes Study 36-Item Short Form Health Survey. The relationships among age, POD, declined cognitive function, and QoL were tested using path analysis. Declined cognitive function was associated with poorer QoL. POD was associated with declined cognitive function but was not associated with poorer QoL. Ageing was not associated with QoL but was associated with POD and declined cognitive function. The QoL of patients developed delirium after CABG is determined by cognitive function after discharge. Necessary strategies should be implemented to prevent POD and declined cognitive function, especially in elderly patients. © 2017 John Wiley & Sons Australia, Ltd.

  13. Indirect effect of financial strain on daily cortisol output through daily negative to positive affect index in the Coronary Artery Risk Development in Young Adults Study.

    Science.gov (United States)

    Puterman, Eli; Haritatos, Jana; Adler, Nancy E; Sidney, Steve; Schwartz, Joseph E; Epel, Elissa S

    2013-12-01

    Daily affect is important to health and has been linked to cortisol. The combination of high negative affect and low positive affect may have a bigger impact on increasing HPA axis activity than either positive or negative affect alone. Financial strain may both dampen positive affect as well as increase negative affect, and thus provides an excellent context for understanding the associations between daily affect and cortisol. Using random effects mixed modeling with maximum likelihood estimation, we examined the relationship between self-reported financial strain and estimated mean daily cortisol level (latent cortisol variable), based on six salivary cortisol assessments throughout the day, and whether this relationship was mediated by greater daily negative to positive affect index measured concurrently in a sample of 776 Coronary Artery Risk Development in Young Adults (CARDIA) Study participants. The analysis revealed that while no total direct effect existed for financial strain on cortisol, there was a significant indirect effect of high negative affect to low positive affect, linking financial strain to elevated cortisol. In this sample, the effects of financial strain on cortisol through either positive affect or negative affect alone were not significant. A combined affect index may be a more sensitive and powerful measure than either negative or positive affect alone, tapping the burden of chronic financial strain, and its effects on biology. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Visit-to-Visit Blood Pressure Variability in Young Adulthood and Hippocampal Volume and Integrity at Middle Age: The CARDIA Study (Coronary Artery Risk Development in Young Adults).

    Science.gov (United States)

    Yano, Yuichiro; Reis, Jared P; Levine, Deborah A; Bryan, R Nick; Viera, Anthony J; Shimbo, Daichi; Tedla, Yacob G; Allen, Norrina B; Schreiner, Pamela J; Bancks, Michael P; Sidney, Stephen; Pletcher, Mark J; Liu, Kiang; Greenland, Philip; Lloyd-Jones, Donald M; Launer, Lenore J

    2017-12-01

    The aims of this study are to assess the relationships of visit-to-visit blood pressure (BP) variability in young adulthood to hippocampal volume and integrity at middle age. We used data over 8 examinations spanning 25 years collected in the CARDIA study (Coronary Artery Risk Development in Young Adults) of black and white adults (age, 18-30 years) started in 1985 to 1986. Visit-to-visit BP variability was defined as by SD BP and average real variability (ARV BP , defined as the absolute differences of BP between successive BP measurements). Hippocampal tissue volume standardized by intracranial volume (%) and integrity assessed by fractional anisotropy were measured by 3-Tesla magnetic resonance imaging at the year-25 examination (n=545; mean age, 51 years; 54% women and 34% African Americans). Mean systolic BP (SBP)/diastolic BP levels were 110/69 mm Hg at year 0 (baseline), 117/73 mm Hg at year 25, and ARV SBP and SD SBP were 7.7 and 7.9 mm Hg, respectively. In multivariable-adjusted linear models, higher ARV SBP was associated with lower hippocampal volume (unstandardized regression coefficient [standard error] with 1-SD higher ARV SBP : -0.006 [0.003]), and higher SD SBP with lower hippocampal fractional anisotropy (-0.02 [0.01]; all P young adulthood may be useful in assessing the potential risk for reductions in hippocampal volume and integrity in midlife. © 2017 American Heart Association, Inc.

  15. Association of obesity in early adulthood and middle age with incipient left ventricular dysfunction and structural remodeling: the CARDIA study (Coronary Artery Risk Development in Young Adults).

    Science.gov (United States)

    Kishi, Satoru; Armstrong, Anderson C; Gidding, Samuel S; Colangelo, Laura A; Venkatesh, Bharath A; Jacobs, David R; Carr, J Jeffery; Terry, James G; Liu, Kiang; Goff, David C; Lima, João A C

    2014-10-01

    The goal of this study was to investigate the relationship of body mass index (BMI) and its 25-year change to left ventricular (LV) structure and function. Longstanding obesity may be associated with clinical cardiac dysfunction and heart failure. Whether obesity relates to cardiac dysfunction during young adulthood and middle age has not been investigated. The CARDIA (Coronary Artery Risk Development in Young Adult) study enrolled white and black adults ages 18 to 30 years in 1985 to 1986 (Year-0). At Year-25, cardiac function was assessed by conventional echocardiography, tissue Doppler imaging (TDI), and speckle tracking echocardiography (STE). Twenty-five-year change in BMI (classified as low: obesity from young adulthood to middle age is associated with impaired LV systolic and diastolic function assessed by conventional echocardiography, TDI, and STE in a large biracial cohort of adults age 43 to 55 years. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. Determinants of Aortic Root Dilatation and Reference Values Among Young Adults Over a 20-Year Period: Coronary Artery Risk Development in Young Adults Study.

    Science.gov (United States)

    Teixido-Tura, Gisela; Almeida, Andre L C; Choi, Eui-Young; Gjesdal, Ola; Jacobs, David R; Dietz, Harry C; Liu, Kiang; Sidney, Stephen; Lewis, Cora E; Garcia-Dorado, David; Evangelista, Artur; Gidding, Samuel; Lima, João A C

    2015-07-01

    Aortic size increases with age, but factors related to such dilatation in healthy young adult population have not been studied. We aim to evaluate changes in aortic dimensions and its principal correlates among young adults over a 20-year time period. Reference values for aortic dimensions in young adults by echocardiography are also provided. Healthy Coronary Artery Risk Development in Young Adults (CARDIA) study participants aged 23 to 35 years in 1990-1991 (n=3051) were included after excluding 18 individuals with significant valvular dysfunction. Aortic root diameter (ARD) by M-mode echocardiography at year-5 (43.7% men; age, 30.2 ± 3.6 years) and year-25 CARDIA exams was obtained. Univariable and multivariable analyses were performed to assess associations of ARD with clinical data at years-5 and -25. ARD from year-5 was used to establish reference values of ARD in healthy young adults. ARD at year-25 was greater in men (33.3 ± 3.7 versus 28.7 ± 3.4 mm; Pyoung adulthood. Our study also provides reference values for ARD in young adults. © 2015 American Heart Association, Inc.

  17. Social relationships and longitudinal changes in body mass index and waist circumference: the coronary artery risk development in young adults study.

    Science.gov (United States)

    Kershaw, Kiarri N; Hankinson, Arlene L; Liu, Kiang; Reis, Jared P; Lewis, Cora E; Loria, Catherine M; Carnethon, Mercedes R

    2014-03-01

    Few studies have examined longitudinal associations between close social relationships and weight change. Using data from 3,074 participants in the Coronary Artery Risk Development in Young Adults Study who were examined in 2000, 2005, and 2010 (at ages 33-45 years in 2000), we estimated separate logistic regression random-effects models to assess whether patterns of exposure to supportive and negative relationships were associated with 10% or greater increases in body mass index (BMI) (weight (kg)/height (m)(2)) and waist circumference. Linear regression random-effects modeling was used to examine associations of social relationships with mean changes in BMI and waist circumference. Participants with persistently high supportive relationships were significantly less likely to increase their BMI values and waist circumference by 10% or greater compared with those with persistently low supportive relationships after adjustment for sociodemographic characteristics, baseline BMI/waist circumference, depressive symptoms, and health behaviors. Persistently high negative relationships were associated with higher likelihood of 10% or greater increases in waist circumference (odds ratio = 1.62, 95% confidence interval: 1.15, 2.29) and marginally higher BMI increases (odds ratio = 1.50, 95% confidence interval: 1.00, 2.24) compared with participants with persistently low negative relationships. Increasingly negative relationships were associated with increases in waist circumference only. These findings suggest that supportive relationships may minimize weight gain, and that adverse relationships may contribute to weight gain, particularly via central fat accumulation.

  18. 'Variant' angina: Evidence for small vessel coronary artery spasm

    International Nuclear Information System (INIS)

    Pfisterer, M.; Mueller-Brand, J.; Cueni, T.; Luetold, B.; Burkart, F.; Basel Univ.

    1980-01-01

    A unique case of 'variant' angina pectoris has been observed in a patient with normal coronary arteries and typical chest pain appearing spontaneously at rest, and repeatedly provoked by ergonovine maleate (0.1 mg iv) associated with large transmural perfusion defects on 201 TI-imaging (after ergonovine) and a marked increase in T wave voltage despite no demonstrable spasm of a major coronary artery after the same doses of ergonovine. While saline solution could not provoke chest pain and treatment with a beta-blocking agent increased the frequency of ischemic attacks, a calcium antangonist therapy reduced and eventually eliminated the attacks. Thus, this case provides evidence for yet another aspect of a 'variant' form of angina pectoris: small vessel coronary artery spasm. (orig.) [de

  19. Coronary Artery Bypass Surgery Versus Drug-Eluting Stent Implantation for Left Main or Multivessel Coronary Artery Disease A Meta-Analysis of Individual Patient Data

    NARCIS (Netherlands)

    Lee, Cheol Whan; Ahn, Jung-Min; Cavalcante, Rafael; Sotomi, Yohei; Onuma, Yoshinobu; Suwannasom, Pannipa; Tenekecioglu, Erhan; Yun, Sung-Cheol; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Park, Seong-Wook; Serruys, Patrick W.; Park, Seung-Jung

    2016-01-01

    OBJECTIVES The authors undertook a patient-level meta-analysis to compare long-term outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in 3,280 patients with left main or multivessel coronary artery disease (CAD).

  20. Clinical and angiographic features of coronary artery disease after chest irradiation

    Energy Technology Data Exchange (ETDEWEB)

    McEniery, P.T.; Dorosti, K.; Schiavone, W.A.; Pedrick, T.J.; Sheldon, W.C.

    1987-11-01

    Coronary artery disease (CAD) developed in 15 patients at a mean of 16 years (range 3 to 29) after chest irradiation. The mean dose of radiation was 42 +/- 7 grays; irradiation was performed for Hodgkin's disease in 9 patients, lymphoma in 2, breast carcinoma in 3 and cystic hygroma in 1 patient. Mean age was 48 years (range 26 to 63) at diagnosis of CAD; 4 patients were younger than 35 years. Nine were women. Ten presented with angina, 3 with acute myocardial infarction, 1 patient with syncope and 1 with dyspnea. Twelve had no more than 2 risk factors of atherosclerosis. At coronary angiography, 8 had at least 50% diameter narrowing of the left main coronary artery and 4 had severe ostial stenosis of the right coronary artery. Eight patients also had valvular heart disease, 4 pericardial disease and 4 complete heart block. Mean left ventricular ejection fraction was 67 +/- 11% (range 53 to 80%). Nine had undergone coronary artery bypass grafting, but surgery was difficult or impossible in 3 because of severe mediastinal and pericardial fibrosis. Radiation-associated CAD is characterized by a high incidence of left main and right ostial coronary disease and often occurs in women with relatively few conventional risk factors for CAD.

  1. Clinical and angiographic features of coronary artery disease after chest irradiation

    International Nuclear Information System (INIS)

    McEniery, P.T.; Dorosti, K.; Schiavone, W.A.; Pedrick, T.J.; Sheldon, W.C.

    1987-01-01

    Coronary artery disease (CAD) developed in 15 patients at a mean of 16 years (range 3 to 29) after chest irradiation. The mean dose of radiation was 42 +/- 7 grays; irradiation was performed for Hodgkin's disease in 9 patients, lymphoma in 2, breast carcinoma in 3 and cystic hygroma in 1 patient. Mean age was 48 years (range 26 to 63) at diagnosis of CAD; 4 patients were younger than 35 years. Nine were women. Ten presented with angina, 3 with acute myocardial infarction, 1 patient with syncope and 1 with dyspnea. Twelve had no more than 2 risk factors of atherosclerosis. At coronary angiography, 8 had at least 50% diameter narrowing of the left main coronary artery and 4 had severe ostial stenosis of the right coronary artery. Eight patients also had valvular heart disease, 4 pericardial disease and 4 complete heart block. Mean left ventricular ejection fraction was 67 +/- 11% (range 53 to 80%). Nine had undergone coronary artery bypass grafting, but surgery was difficult or impossible in 3 because of severe mediastinal and pericardial fibrosis. Radiation-associated CAD is characterized by a high incidence of left main and right ostial coronary disease and often occurs in women with relatively few conventional risk factors for CAD

  2. Coronary artery analysis: Computer-assisted selection of best-quality segments in multiple-phase coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Chuan, E-mail: chuan@umich.edu; Chan, Heang-Ping; Hadjiyski, Lubomir M.; Chughtai, Aamer; Wei, Jun; Kazerooni, Ella A. [Department of Radiology, The University of Michigan, Ann Arbor, Michigan 48109-0904 (United States)

    2016-10-15

    Purpose: The authors are developing an automated method to identify the best-quality coronary arterial segment from multiple-phase coronary CT angiography (cCTA) acquisitions, which may be used by either interpreting physicians or computer-aided detection systems to optimally and efficiently utilize the diagnostic information available in multiple-phase cCTA for the detection of coronary artery disease. Methods: After initialization with a manually identified seed point, each coronary artery tree is automatically extracted from multiple cCTA phases using our multiscale coronary artery response enhancement and 3D rolling balloon region growing vessel segmentation and tracking method. The coronary artery trees from multiple phases are then aligned by a global registration using an affine transformation with quadratic terms and nonlinear simplex optimization, followed by a local registration using a cubic B-spline method with fast localized optimization. The corresponding coronary arteries among the available phases are identified using a recursive coronary segment matching method. Each of the identified vessel segments is transformed by the curved planar reformation (CPR) method. Four features are extracted from each corresponding segment as quality indicators in the original computed tomography volume and the straightened CPR volume, and each quality indicator is used as a voting classifier for the arterial segment. A weighted voting ensemble (WVE) classifier is designed to combine the votes of the four voting classifiers for each corresponding segment. The segment with the highest WVE vote is then selected as the best-quality segment. In this study, the training and test sets consisted of 6 and 20 cCTA cases, respectively, each with 6 phases, containing a total of 156 cCTA volumes and 312 coronary artery trees. An observer preference study was also conducted with one expert cardiothoracic radiologist and four nonradiologist readers to visually rank vessel segment

  3. Coronary artery analysis: Computer-assisted selection of best-quality segments in multiple-phase coronary CT angiography

    International Nuclear Information System (INIS)

    Zhou, Chuan; Chan, Heang-Ping; Hadjiyski, Lubomir M.; Chughtai, Aamer; Wei, Jun; Kazerooni, Ella A.

    2016-01-01

    Purpose: The authors are developing an automated method to identify the best-quality coronary arterial segment from multiple-phase coronary CT angiography (cCTA) acquisitions, which may be used by either interpreting physicians or computer-aided detection systems to optimally and efficiently utilize the diagnostic information available in multiple-phase cCTA for the detection of coronary artery disease. Methods: After initialization with a manually identified seed point, each coronary artery tree is automatically extracted from multiple cCTA phases using our multiscale coronary artery response enhancement and 3D rolling balloon region growing vessel segmentation and tracking method. The coronary artery trees from multiple phases are then aligned by a global registration using an affine transformation with quadratic terms and nonlinear simplex optimization, followed by a local registration using a cubic B-spline method with fast localized optimization. The corresponding coronary arteries among the available phases are identified using a recursive coronary segment matching method. Each of the identified vessel segments is transformed by the curved planar reformation (CPR) method. Four features are extracted from each corresponding segment as quality indicators in the original computed tomography volume and the straightened CPR volume, and each quality indicator is used as a voting classifier for the arterial segment. A weighted voting ensemble (WVE) classifier is designed to combine the votes of the four voting classifiers for each corresponding segment. The segment with the highest WVE vote is then selected as the best-quality segment. In this study, the training and test sets consisted of 6 and 20 cCTA cases, respectively, each with 6 phases, containing a total of 156 cCTA volumes and 312 coronary artery trees. An observer preference study was also conducted with one expert cardiothoracic radiologist and four nonradiologist readers to visually rank vessel segment

  4. [Successful correction with stent-graft of coronary artery rupture after angioplasty].

    Science.gov (United States)

    Demin, V V

    2003-01-01

    Rupture and perforation of coronary arteries complicate in average 0.5% of radiosurgical coronary interventions and often are accompanied by serious consequences and high mortality. According to-type of coronary perforation different methods of correction are used, ranging from conservative measures to urgent cardiosurgical interventions. Coronary stent-grafts with 'sandwich' type of construction ore composed from two metal stents and PTFE layer between them. Development of such stents enabled effective radioguided endovascular repair of coronary ruptures. The paper presents the first Russian experience of stout-graft implantation for coronary artery rupture occurred during direct stenting of proximal anterior descending artery and balloon angioplasty in distal segment. The rupture occurred probably because of wall fragility between affected segment and muscular bridge. Stent-graft JoStent 16 mm in length connected with 3-mm balloon was implanted with subsequent complete restitution of blood flow, resolution of pain syndrome and ECG normalization. Echocardiography in operative theatre and one day after surgery showed no intrapericardial fluid. Stent-graft devices for urgent implantation in cases of coronary rupture must be included into obligatory equipment of radiosurgical facilities.

  5. The association of ABO blood groups with extent of coronary atherosclerosis in Croatian patients suffering from chronic coronary artery disease.

    Science.gov (United States)

    Karabuva, Svjetlana; Carević, Vedran; Radić, Mislav; Fabijanić, Damir

    2013-01-01

    The aim of study was to: 1) examine the relationship between ABO blood groups and extent of coronary atherosclerosis in patients with chronic coronary artery disease (CAD), 2) compare ABO blood groups distribution in CAD patients and general population, 3) examine possible differences in traditional risk factors frequency in CAD patients with different ABO blood groups. In the 646 chronic CAD patients (72.4% males) coronary angiograms were scored by quantitative assessment using multiple angiographic scoring system, Traditional risk factors were self reported or measured by standard methods. ABO blood distribution of patients was compared with group of 651 healthy blood donors (74.6% males). Among all ABO blood group patients there was no significant difference between the extent of coronary atherosclerosis with regard to all the three scoring systems: number of affected coronary arteries (P = 0.857), Gensini score (P = 0.818), and number of segments narrowed > 50% (P = 0.781). There was no significant difference in ABO blood group distribution between CAD patients and healthy blood donors. Among CAD patients, men with blood group AB were significantly younger than their pairs with non-AB blood groups (P = 0.008). Among CAD patients with AB blood group, males groups (P = 0.003). No association between ABO blood groups and the extent of coronary atherosclerosis in Croatian CAD patients is observed. Observation that AB blood group might possibly identify Croatian males at risk to develop the premature CAD has to be tested in larger cohort of patients.

  6. Prevalence of diabetes mellitus among obese and non-obese patients with coronary artery disease

    International Nuclear Information System (INIS)

    Khan, S.B.; Rehman, H.U.; Hafeezullah, M.; Gul, A.M.

    2010-01-01

    Background: Globally, obesity is now recognised as an epidemic. The degree of obesity is proportional to the rate of development of cardiovascular diseases, hence, resulting in a dramatic increase in morbidity and mortality. Apart from obesity, diabetes mellitus is another well recognised risk factor contributing to coronary artery disease. The precise prevalence of obesity-related diabetes varies with age, race and gender; and is yet unknown in our population. We therefore, carried out study with the aim to determine the prevalence of diabetes mellitus in obese and non-obese patients with diagnosed coronary artery disease. Methods: This hospital based cross-sectional comparative study was conducted in Cardiology Department of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, from March 15, 2005 to May 30, 2006. A total of 200 patients with diagnosed coronary artery disease were enrolled, 100 were classified as obese and 100 as non-obese. Results: Among these, 139 patients were male and 61 female. A total of 88 were found to be diabetic, 54 of these were obese and 34 non-obese (p =0.004). Conclusion: Diabetes mellitus was significantly more frequent among obese patients with coronary artery disease as compared to non obese patients with coronary artery disease. (author)

  7. Multi-detector CT coronary angiographic findings of coronary-to-pulmonary artery fistula

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Seok; Park, Eun Ah; Lim, Ji Yeon; Lee, Whal [Dept. of Radiology, Seoul National University Hospital, Seoul (Korea, Republic of); Park, Jae Hyung [Dept. of Radiology, Myongji Hospital, Seonam University College of Medicine, Goyang (Korea, Republic of)

    2017-01-15

    To evaluate multi-detector CT (MDCT) coronary angiographic findings of coronary-to-pulmonary artery fistula (CPAF). We retrospectively reviewed images of patients with CPAF from the coronary CT angiography (CCTA) database obtained with a 64-channel MDCT between January 2008 and March 2011. We analyzed the CCTA findings for feeding arteries, fistula, association with peripulmonary arterial aneurysms, and the presence of communication between the CPAF and bronchial arteries. Fifty-five of the 15042 (0.37%) patients were diagnosed with CPAFs. The feeding artery was single (n = 18) or multiple (n = 37). The fistula had a single drainage site (n = 54) or multiple drainage sites (n = 1). The mean diameter of the fistulous opening was 2.7 ± 1.4 mm. A peripulmonary arterial aneurysm was present in 24 (44%) patients. Communication between CPAF and bronchial arteries was present in eight (14.5%) patients. MDCT coronary angiography can provide comprehensive morphologic details on CPAF and may help in presurgical or preinterventional planning.

  8. Subclinical Coronary Plaque Burden in Asymptomatic Relatives of Patients With Documented Premature Coronary Artery Disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh; Jensen, Jesper Møller; Bøtker, Hans Erik

    Introduction: A family history of premature coronary artery disease (CAD) is a well-known risk factor for adverse coronary events with age of onset being inversely related to the degree of heritability. Hypothesis: We hypothesized that asymptomatic first degree relatives, of patients with premature...... CAD, suffer a high burden of subclinical coronary atherosclerosis. Methods: First degree relatives, aged 30-65 years, of patients with a documented coronary revascularization procedure before the age of 40 years, were invited to participate in the study. Participants were matched by age, sex...... and absence of a family history, with patients referred for coronary CT angiography (CTA) because of atypical angina or non-anginal chest pain. A pooled blinded analysis was performed. The main outcome measure was the number of plaque-affected coronary segments. Results: 88 relatives and 88 symptomatic...

  9. [Development of an automated processing method to detect coronary motion for coronary magnetic resonance angiography].

    Science.gov (United States)

    Asou, Hiroya; Imada, N; Sato, T

    2010-06-20

    On coronary MR angiography (CMRA), cardiac motions worsen the image quality. To improve the image quality, detection of cardiac especially for individual coronary motion is very important. Usually, scan delay and duration were determined manually by the operator. We developed a new evaluation method to calculate static time of individual coronary artery. At first, coronary cine MRI was taken at the level of about 3 cm below the aortic valve (80 images/R-R). Chronological change of the signals were evaluated with Fourier transformation of each pixel of the images were done. Noise reduction with subtraction process and extraction process were done. To extract higher motion such as coronary arteries, morphological filter process and labeling process were added. Using these imaging processes, individual coronary motion was extracted and individual coronary static time was calculated automatically. We compared the images with ordinary manual method and new automated method in 10 healthy volunteers. Coronary static times were calculated with our method. Calculated coronary static time was shorter than that of ordinary manual method. And scan time became about 10% longer than that of ordinary method. Image qualities were improved in our method. Our automated detection method for coronary static time with chronological Fourier transformation has a potential to improve the image quality of CMRA and easy processing.

  10. Breath-hold two-dimensional MR angiography of coronary arteries. Comparison with conventional coronary angiography in ten cases

    International Nuclear Information System (INIS)

    Li Liwei; Zhang Wanshi; Liu Chaozhong; Lu Xiaoyan; Xu Jiaxing

    1997-01-01

    Purpose: To assess the diagnostic value of two-dimensional coronary magnetic resonance (MR) angiography in patients evaluated for ischemic heart disease. Materials and methods: Ten patients who underwent selective cardiac catheterization with coronary MR angiography were evaluated with two-dimensional coronary MR angiography. Coronary MR angiography was performed with breath-hold fat-suppressed ECG-gated Turbo-FLASH with K-space segmentation using a 1.5 T imager. Results: The left main coronary artery, proximal left anterior descending artery, circumflex artery and right coronary artery were demonstrated in all cases. Continuous segments (mean) of left anterior descending, circumflex and right coronary arteries visualized on MRA were 6.72 +- 3.16 cm, 3.67 +- 4.81 cm and 7.93 +- 3.12 cm respectively. The overall sensitivity for detection of hemodynamically significant coronary artery lesion (≥50%) was 62.5% respectively. Conclusion: Breath-hold two-dimensional coronary MR angiography was useful in showing relatively long segments of the main coronary arteries and also has potential in depicting hemodynamically significant coronary artery lesions

  11. Spontaneous Right Coronary Artery Rupture and Acute Cardiac Tamponade in Behçet's Disease.

    Science.gov (United States)

    Keskin, Muhammed; Bozbay, Mehmet; Kayacıoğlu, İlyas; Koçoğulları, Cevdet; Bozbay, Ayfer Yıldız; Hayıroğlu, Mert İlker; Gürkan, Ufuk; Eren, Mehmet

    2016-11-01

    Coronary involvement in Behçet's disease is extremely rare and it can bring devastating consequences when it occurs. In this report, we present a 29-year-old male patient with Behçet's disease who developed rapidly changing and progressive coronary artery involvements under medical treatment. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  12. Rest period duration of the coronary arteries: Implications for magnetic resonance coronary angiography

    International Nuclear Information System (INIS)

    Shechter, Guy; Resar, Jon R.; McVeigh, Elliot R.

    2005-01-01

    Magnetic resonance (MR) and computed tomography coronary imaging is susceptible to artifacts caused by motion of the heart. The presence of rest periods during the cardiac and respiratory cycles suggests that images free of motion artifacts could be acquired. In this paper, we studied the rest period (RP) duration of the coronary arteries during a cardiac contraction and a tidal respiratory cycle. We also studied whether three MR motion correction methods could be used to increase the respiratory RP duration. Free breathing x-ray coronary angiograms were acquired in ten patients. The three-dimensional (3D) structure of the coronary arteries was reconstructed from a biplane acquisition using stereo reconstruction methods. The 3D motion of the arterial model was then recovered using an automatic motion tracking algorithm. The motion field was then decomposed into separate cardiac and respiratory components using a cardiac respiratory parametric model. For the proximal-to-middle segments of the right coronary artery (RCA), a cardiac RP (<1 mm 3D displacement) of 76±34 ms was measured at end systole (ES), and 65±42 ms in mid-diastole (MD). The cardiac RP was 80±25 ms at ES and 112±42 ms at MD for the proximal 5 cm of the left coronary tree. At end expiration, the respiratory RP (in percent of the respiratory period) was 26±8% for the RCA and 27±17% for the left coronary tree. Left coronary respiratory RP (<0.5 mm 3D displacement) increased with translation (32% of the respiratory period), rigid body (51%), and affine (79%) motion correction. The RCA respiratory RP using translational (27%) and rigid body (33%) motion correction were not statistically different from each other. Measurements of the cardiac and respiratory rest periods will improve our understanding of the temporal and spatial resolution constraints for coronary imaging

  13. Arterial Stiffness and its Correlation with the Extent of Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Hourak Poorzand

    2018-06-01

    Full Text Available Introduction: Coronary artery disease secondary to atherosclerosis is the most common cause of mortality. Coronary angiography is the most precise method for determining the extent of disease in the coronary vascular bed. Arterial stiffness has been proposed as a marker of atherosclerosis in some studies. One of the noninvasive methods for the determination of arterial stiffness is Doppler echocardiography. In this study, we aimed to find the correlation between arterial stiffness as measured by echocardiography and the extent of coronary artery disease as evaluated through angiography. Materials and Methods: Aortic pulse wave velocity (APWV was measured by using the Doppler method in 70 patients, who were candidates for coronary angiography. The extent of coronary artery disease was determined quantitatively in terms of Friesinger index and semi-quantitatively as the number of vessels with stenosis of over 50%. Then, the correlation between arterial stiffness and these factors was evaluated. Results: The mean APWV was 9.1±5 m/s. There was a direct relationship between APWV and Friesinger index, which was not statistically significant (P=0.67. The mean APWV for patients with one-vessel disease was 4.4±1.8 m/s, while it was 9.9±3.6 m/s in patients with two and 7.9±4 m/s in three-vessel disease which did not show statistically significant difference. Conclusion: Doppler echocardiography to measure APWV was not considered as a promising tool to predict the extent of coronary artery disease.

  14. Increased bleeding risk during percutaneous coronary interventions by arterial hypertension.

    Science.gov (United States)

    Ndrepepa, Gjin; Groha, Philipp; Lahmann, Anna L; Lohaus, Raphaela; Cassese, Salvatore; Schulz-Schüpke, Stefanie; Kufner, Sebastian; Mayer, Katharina; Bernlochner, Isabell; Byrne, Robert A; Fusaro, Massimiliano; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Kastrati, Adnan

    2016-08-01

    We aimed to assess the association between arterial hypertension and bleeding in patients undergoing percutaneous coronary intervention (PCI). The impact of arterial hypertension on bleeding risk of patients with coronary artery disease undergoing PCI is unknown. This study included 14,180 patients who underwent PCI. Bleeding was defined using the Bleeding Academic Research Consortium (BARC) criteria. Arterial hypertension was defined as treatment with antihypertensive drugs or a systolic blood pressure >140 mm Hg and/or diastolic blood pressure value >90 mm Hg documented on at least 2 occasions. The primary outcome was bleeding rate within 30 days of PCI. Overall, 11,066 patients (78.0%) had arterial hypertension. Bleeding events occurred in 1,232 patients with arterial hypertension and 278 patients without arterial hypertension (11.1% vs 8.9%; odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.11-1.46, P arterial hypertension and 175 patients without arterial hypertension (6.6% vs 5.6%: OR = 1.19 [1.01-1.41], P = 0.049). Non-access-site bleeding occurred in 502 patients with and 103 patients without arterial hypertension (4.5% vs 3.3%; OR = 1.39 [1.12-1.72], P = 0.003). After adjustment, arterial hypertension was significantly associated with any bleeding (adjusted OR = 1.41 [1.19-1.67], P arterial hypertension increased the risk of non-access-site bleeding (P = 0.002), whereas systolic blood pressure at the time of PCI increased the risk of access site bleeding (P = 0.018). Arterial hypertension is associated with increased risk of bleeding during PCI procedures. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  15. Radiation for not-so-benign coronary artery disease

    International Nuclear Information System (INIS)

    Massullo, Vincent

    1996-01-01

    The role of radiation therapy in the treatment of malignant disease has long been accepted. More limited application of radiation in the treatment of benign conditions has been proven but generally not pursued. On the centennial anniversary of radiation therapy, a promising, but as yet unproved, application of radiation for treatment of benign vascular disease has become an exciting field of research, speculation, and controversy. This panel presentation will discuss the rationales and dilemmas of applying radiation in the prevention of arterial restenosis after therapeutic intervention. Coronary artery bypass grafting and more recently coronary angioplasty have become accepted, effective therapies to reverse significant coronary stenosis, and thereby benefit the majority of patients with coronary artery disease. However, a large proportion of patients will suffer restenosis in spite of optimal conventional therapy. The search for a means to prevent such restenosis has been partially successful by therapies, and even engineering intravascular devices. In spite of these efforts, a significant number of patients will fail today's conventional therapy and suffer arterial restenosis. Fibroblast myointimal proliferation is felt to be a major element in this restenosis process. Clinical experience shows that radiation inhibits other similar benign fibroblast proliferative processes such as keloid scar formation and heterotopic ossification. Radiation is now being considered as a means to inhibit myointimal fibroblast proliferation and hopefully prevent attendant arterial restenosis as well. This has catalyzed various animal model investigations that have shown significant arteries. Promising results in the animal model and in very early human institutional trials. These trials are designed to determine if radiation is truly effective and can be safely delivered to prevent restenosis in diseased human arteries. This panel discussion will provide a firm basic science and

  16. Peripheral arterial tonometry cannot detect patients at low risk of coronary artery disease

    NARCIS (Netherlands)

    M.M. van den Heuvel (Mieke); O. Sorop (Oana); P. Musters (Paul); R.T. van Domburg (Ron); T.W. Galema (Tjebbe); D.J.G.M. Duncker (Dirk); W.J. van der Giessen (Wim); K. Nieman (Koen)

    2015-01-01

    textabstractBackground Endothelial dysfunction precedes coronary artery disease (CAD) and can be measured by peripheral arterial tonometry (PAT). We examined the applicability of PAT to detect a low risk of CAD in a chest pain clinic. Methods In 93 patients, PAT was performed resulting in reactive

  17. Hypertension, obesity, and coronary artery disease in the survivors of congenital heart disease.

    Science.gov (United States)

    Roche, S Lucy; Silversides, Candice K

    2013-07-01

    Obesity, hypertension, and coronary artery disease are prevalent in the general population and well recognized as contributors to cardiac morbidity and mortality. With surgical and medical advances, there is a growing and aging population with congenital heart disease who are also at risk of developing these comorbidities. In addition, some congenital cardiac lesions predispose patients to conditions such as hypertension or coronary artery disease. The effect of these comorbidities on the structurally abnormal heart is not well understood, but might be very important, especially in those with residual abnormalities. Thus, in addition to surveillance for and treatment of late complications it is important for the congenital cardiologist to consider and aggressively manage acquired comorbidities. In this review we explore the prevalence of hypertension, obesity, and coronary artery disease, discuss congenital lesions that predispose to these conditions and review management strategies for this unique population. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  18. Impact of gender on outcome after coronary artery bypass surgery.

    Science.gov (United States)

    Ennker, Ina C; Albert, Alexander; Pietrowski, Detlef; Bauer, Kerstin; Ennker, Juergen; Florath, Ines

    2009-06-01

    Following recent studies concerning the increased risk of coronary artery bypass surgery for women, the impact of sex is still a controversial issue. Between 1996 and 2006, 9,527 men and 3,079 women underwent isolated coronary artery bypass in our institute. To adjust for dissimilarities in preoperative risk profiles, propensity score-based matching was applied. Before adjustment, clinical outcomes in terms of operative mortality, arrhythmias, intensive care unit stay, and maximum creatine kinase-MB levels were significantly different for men and women. After balancing the preoperative characteristics, including height, no significant differences in clinical outcomes were observed. However, there was decreased use of internal mammary artery, less total arterial revascularization, and increasing creatine kinase-MB levels with decreasing height. This study supports the theory that female sex per se does not increase operative risk, but shorter height, which is more common in women, affects the outcome, probably due to technical difficulties in shorter patients with smaller internal mammary arteries and coronary vessels. Thus women may especially benefit from sequential arterial grafting.

  19. 64 multislice computed tomography imaging of coronary artery origin anomalies in adults

    International Nuclear Information System (INIS)

    Dai Qinyi; Lv Biao; Zhang Zhaoqi

    2006-01-01

    Objective: To assess the value of 64 multislice computed tomography (64 MSCT) in the evaluation of coronary artery origin anomalies in adults. Methods: Nine hundred and seventy eight Chinese adult patients undergone coronary artery CT angiography (CTA) between March and July 2005 at Anzhen hospital were reviewed for this study. Results: In consecutive 978 patients, 64 MSCT identified (3.07%) with an anomalous origin of the coronary artery, in 30 patients including anomalous origin of the right coronary artery (RCA) in 9 patients, the left coronary artery (LCA)in 7 patients, both RCA and LCA in 2 patients, the absence of the left circumflex artery (LCX) in 1 patient and anomalous origin of the branch of coronary artery in 11 patients. Conclusion: Noninvasive 64 multislice computed tomography can detect the anomalous origin of the coronary artery with high resolution. (authors)

  20. Anatomical studies of the coronary system in elasmobranchs: II. Coronary arteries in hexanchoid, squaloid, and carcharhinoid sharks.

    Science.gov (United States)

    De Andrés, A V; Muñoz-Chápuli, R; Sans-Coma, V; García-Garrido, L

    1992-07-01

    Coronary artery anatomy was studied in 16 shark species belonging to 9 families of the orders Hexanchiformes, Squaliformes, and Carcharhiniformes. The study included 101 specimens and used an injection-corrosion technique that obtained internal casts of the main trunks and coronary arterial branches. The results showed 2 main patterns of coronary arterial arrangement: the dorsoventral coronary trunk pattern, shared by lamnoid and advanced carcharhinoid sharks, and the lateral coronary trunk pattern, shown by hexanchoid and squaloid sharks. Scyliorhinus and Galeus had intermediate arrangements of their vessels.

  1. Single left coronary ostium and an anomalous prepulmonic right coronary artery in 2 dogs with congenital pulmonary valve stenosis.

    Science.gov (United States)

    Visser, Lance C; Scansen, Brian A; Schober, Karsten E

    2013-06-01

    A coronary artery anomaly characterized by the presence of a single left coronary ostium with absence of the right coronary ostium and an anomalous prepulmonic right coronary artery course was observed in two dogs with concurrent congenital pulmonary valve stenosis. This unique coronary artery anatomy is similar to the previously described single right coronary ostium with anomalous prepulmonic left coronary artery, the so-called type R2A anomaly, in that an anomalous coronary artery encircles the pulmonary valve annulus. Both dogs of this report, a boxer and an English bulldog, were of breeds known to be at risk for the type R2A anomaly. As such, veterinarians should be aware that the echocardiographic presence of a left coronary ostium in a dog with pulmonary valve stenosis does not exclude the possibility of a prepulmonic coronary artery anomaly that may enhance the risk of complications during balloon pulmonary valvuloplasty. A descriptive naming convention for coronary artery anomalies in dogs is also presented, which may be preferable to the older coding classification scheme. Copyright © 2013 Elsevier B.V. All rights reserved.

  2. Aborted sudden cardiac death in a young male with anomalous left coronary artery arising from the pulmonary artery

    Directory of Open Access Journals (Sweden)

    Chih-Han Huang

    2017-01-01

    Full Text Available Anomalous left coronary artery arising from the pulmonary artery (ALCAPA is a rare type of congenital coronary abnormality that may be associated with early infant mortality and sudden adult cardiac death. We report a case regarding a 23-year-old male who collapsed during a marathon race and was resuscitated with cardiopulmonary resuscitation. Subsequent workups verified the diagnosis of ALCAPA. The patient underwent surgical intervention with obliteration of the ALCAPA orifice and coronary artery bypass grafting with left internal mammary artery to left anterior descending coronary artery. The procedure was done smoothly, and he was discharged uneventfully.

  3. Anomalous left coronary artery from the pulmonary artery with a large patent ductus arteriosus: aversion of a catastrophe.

    Science.gov (United States)

    Aggarwal, Sanjeev; Delius, Ralph E; Pettersen, Michael D

    2013-01-01

    We present an infant who had an anomalous left coronary artery arising from the pulmonary artery (ALCAPA) and a large patent ductus arteriosus (PDA), who was diagnosed before a potentially catastrophic closure of PDA. In the presence of normal left ventricular function and the absence of coronary artery collaterals, it is difficult to diagnose ALCAPA. A disproportionate degree of left ventricular dilation and severity of mitral valve regurgitation relative to the degree of PDA shunt, and echogenic papillary muscles on an echocardiogram should raise a suspicion of coronary artery anomalies. The infant underwent surgical ligation of PDA with translocation of coronary arteries and had an uneventful recovery. © 2012 Wiley Periodicals, Inc.

  4. Coronary CT angiography in clinical triage of patients at high risk of coronary artery disease

    DEFF Research Database (Denmark)

    Kühl, J Tobias; Hove, Jens D; Kristensen, Thomas S

    2017-01-01

    OBJECTIVES: To test if cardiac computed tomography angiography (CCTA) can be used in the triage of patients at high risk of coronary artery disease. DESIGN: The diagnostic value of 64-detector CCTA was evaluated in 400 patients presenting with non-ST segment elevation myocardial infarction using...... invasive coronary angiography (ICA) as the reference method. The relation between the severity of disease by CCTA and a combined endpoint of death, re-hospitalization due to new myocardial infarction, or symptom-driven coronary revascularization was assessed. RESULTS: CCTA detects significant (>50...... in patients with high likelihood of coronary artery disease and could, in theory, be used to triage high risk patients. As many obstacles remain, including logistical and safety issues, our study does not support the use of CCTA as an additional diagnostic test before ICA in an all-comer NSTEMI population....

  5. Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Hüche Nielsen, Lene; Bøtker, Hans Erik; Sørensen, Henrik T.

    2017-01-01

    Aims: To examine the 3.5 year prognosis of stable coronary artery disease (CAD) as assessed by coronary computed tomography angiography (CCTA) in real-world clinical practice, overall and within subgroups of patients according to age, sex, and comorbidity. Methods and results: This cohort study......, and comorbidity. Conclusion: Coronary artery disease determined by CCTA in real-world practice predicts the 3.5 year composite risk of late revascularization, myocardial infarction, and all-cause death across different groups of age, sex, or comorbidity burden....... included 16,949 patients (median age 57 years; 57% women) with new-onset symptoms suggestive of CAD, who underwent CCTA between January 2008 and December 2012. The endpoint was a composite of late coronary revascularization procedure >90 days after CCTA, myocardial infarction, and all-cause death...

  6. Posttraumatic stress disorder after myocardial infarction and coronary artery bypass grafting.

    Science.gov (United States)

    Singh, Amitoj; Agrawal, Sahil; Gargya, Sanchita; Saluja, Sabir; Kumar, Akshat; Kumar, Abhishek; Kalra, Kartik; Thind, Munveer; Saluja, Sajeev; Stone, Lauren E; Ali, Farhan; Duarte-Chavez, Rodrigo; Marchionni, Christine; Sholevar, Farhad; Shirani, Jamshid; Nanda, Sudip

    2017-01-01

    Post traumatic stress disorder is a psychiatric disease that is usually precipitated by life threatening stressors. Myocardial infarction, especially in the young can count as one such event. The development of post traumatic stress after a coronary event not only adversely effects psychiatric health, but leads to increased cardiovascular morbidity and mortality. There is increasing evidence that like major depression, post traumatic stress disorder is also a strong coronary risk factor. Early diagnosis and treatment of this disease in patients with acute manifestations of coronary artery disease can improve patient outcomes.

  7. Thirty Years Later: Evolution of Treatment for Acute Left Main Coronary Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Moshe Y. Flugelman

    2016-01-01

    Full Text Available Acute occlusion of left main coronary artery is a catastrophic event. We describe two patients with acute occlusion of the left main coronary artery treated thirty years apart. The first patient was treated in 1982 and survived the event without revascularization but developed severe heart failure. His survival was so unusual that it merited a case report at that time. The second patient was treated at the end of 2015. Early revascularization resulted in myocardial reperfusion and near normal left ventricular function. These patients exemplify the progress in therapeutic cardiology over the last 30 years.

  8. Prediction of coronary artery disease in patients undergoing operations for mitral valve degeneration

    Science.gov (United States)

    Lin, S. S.; Lauer, M. S.; Asher, C. R.; Cosgrove, D. M.; Blackstone, E.; Thomas, J. D.; Garcia, M. J.

    2001-01-01

    OBJECTIVES: We sought to develop and validate a model that estimates the risk of obstructive coronary artery disease in patients undergoing operations for mitral valve degeneration and to demonstrate its potential clinical utility. METHODS: A total of 722 patients (67% men; age, 61 +/- 12 years) without a history of myocardial infarction, ischemic electrocardiographic changes, or angina who underwent routine coronary angiography before mitral valve prolapse operations between 1989 and 1996 were analyzed. A bootstrap-validated logistic regression model on the basis of clinical risk factors was developed to identify low-risk (< or =5%) patients. Obstructive coronary atherosclerosis was defined as 50% or more luminal narrowing in one or more major epicardial vessels, as determined by means of coronary angiography. RESULTS: One hundred thirty-nine (19%) patients had obstructive coronary atherosclerosis. Independent predictors of coronary artery disease include age, male sex, hypertension, diabetes mellitus,and hyperlipidemia. Two hundred twenty patients were designated as low risk according to the logistic model. Of these patients, only 3 (1.3%) had single-vessel disease, and none had multivessel disease. The model showed good discrimination, with an area under the receiver-operating characteristic curve of 0.84. Cost analysis indicated that application of this model could safely eliminate 30% of coronary angiograms, corresponding to cost savings of $430,000 per 1000 patients without missing any case of high-risk coronary artery disease. CONCLUSION: A model with standard clinical predictors can reliably estimate the prevalence of obstructive coronary atherosclerosis in patients undergoing mitral valve prolapse operations. This model can identify low-risk patients in whom routine preoperative angiography may be safely avoided.

  9. Prediction of coronary artery disease in patients undergoing operations for mitral valve degeneration

    Science.gov (United States)

    Lin, S. S.; Lauer, M. S.; Asher, C. R.; Cosgrove, D. M.; Blackstone, E.; Thomas, J. D.; Garcia, M. J.

    2001-01-01

    OBJECTIVES: We sought to develop and validate a model that estimates the risk of obstructive coronary artery disease in patients undergoing operations for mitral valve degeneration and to demonstrate its potential clinical utility. METHODS: A total of 722 patients (67% men; age, 61 +/- 12 years) without a history of myocardial infarction, ischemic electrocardiographic changes, or angina who underwent routine coronary angiography before mitral valve prolapse operations between 1989 and 1996 were analyzed. A bootstrap-validated logistic regression model on the basis of clinical risk factors was developed to identify low-risk (coronary atherosclerosis was defined as 50% or more luminal narrowing in one or more major epicardial vessels, as determined by means of coronary angiography. RESULTS: One hundred thirty-nine (19%) patients had obstructive coronary atherosclerosis. Independent predictors of coronary artery disease include age, male sex, hypertension, diabetes mellitus,and hyperlipidemia. Two hundred twenty patients were designated as low risk according to the logistic model. Of these patients, only 3 (1.3%) had single-vessel disease, and none had multivessel disease. The model showed good discrimination, with an area under the receiver-operating characteristic curve of 0.84. Cost analysis indicated that application of this model could safely eliminate 30% of coronary angiograms, corresponding to cost savings of $430,000 per 1000 patients without missing any case of high-risk coronary artery disease. CONCLUSION: A model with standard clinical predictors can reliably estimate the prevalence of obstructive coronary atherosclerosis in patients undergoing mitral valve prolapse operations. This model can identify low-risk patients in whom routine preoperative angiography may be safely avoided.

  10. Wall thickness of major coronary arteries in Pakistani population

    International Nuclear Information System (INIS)

    Ullah, Q.W.; Qamar, K.; Butt, S.A.; Butt, S.A.

    2012-01-01

    To measure the wall thickness of major coronary arteries in Pakistani population, through micrometry. Study design: An observational study. Place and duration of study: Combined Military Hospital Rawalpindi, Khyber Medical College Peshawar and District Headquarter Hospital, Rawalpindi, in collaboration with Departments of Anatomy and Pathology, Army Medical College Rawalpindi. The duration of study was six months with effect from September 2009 to March 2010. Material and methods: After incising pericardium, 1 mm long segments of major coronary arteries i.e. right coronary artery (RCA), left anterior descending artery (LAD) and left circumflex artery (LCX) were taken 1cm distal to their origin, from adult male cadavers of up to 40 years age. After processing for paraffin embedding, 5 mu m thick sections were prepared, mounted on glass slides and subsequently stained with Hematoxylin and Eosin (H and E) for routine histological study. Verhoeff's elastic stain was used to make the elastic lamina more prominent. Wall thickness for each section was measured through micrometry, circumferentially at eight different places along the planes at 45 deg. to each other and then their mean taken as a reading for the respective artery. Results: The total wall thickness of major coronary arteries and of the individual tunicae was less in Pakistani population. The mean thickness of RCA was 0.61 +- 0.05 mm; LAD had mean thickness of 0.55 +- 0.06 mm whereas that of LCX was 0.66 +- 0.13 mm. The mean thickness of tunica intima of RCA was noted to be 0.230 +- 0.044 mm; tunica media measured 0.205 +- 0.031 mm whereas tunica adventitia was 0.172 +- 0.023 mm thick. The mean thickness of tunica intima of LAD measured 0.156 +- 0.032 mm; tunica media was observed to be 0.224 +- 0.026 mm thick whereas the tunica adventitia was 0.170 +- 0.032 mm thick. The mean thickness of tunica intima of LCX was observed to be 0.203 +- 0.059 mm; tunica media to be 0.282 +- 0.097 mm whereas that of tunica

  11. DOMINANCE OF CORONARY ARTERY DISEASE AMONG PATIENTS WITH ANEURYSM OF ABDOMINAL AORTA

    Directory of Open Access Journals (Sweden)

    Maja Zdravkovic

    2007-12-01

    Full Text Available Persons with aneurysm of the abdominal aorta have high prevalence of risk factors of cardiovascular disease. It cannot be stated with certainty whether these persons die in a large number due to the existence of risk factors or the genesis and complications of aneurysm itself. In patients with aneurysm of the abdominal aorta, there is a high correlation with the coronary artery disease; therefore, the aim of the study was to prove whether or not this is the case. The patients in preparation for the resection of the abdominal aorta aneurysm at the Institute of Cardiovascular Disease underwent the examination. The study included 377 examinees, of whom 341 males and 36 females, aged 45 to 83 years, during the three-year interval (from 2004 to 2006. The aim of the study was to determine the dominance of the coronary artery disease among the patients with aneurysm of the abdominal aorta. In the process of analyzing the data obtained from patients and medical evidence, it was found out that a large number of the abdominal aortic aneurysm patients were at the same time the coronary artery disease patients (55,2%; Hi=15,04; p80 kg was larger, as well as the percentage of patients with hypertension (89% and increased levels of cholesterol and triglycerides (67%. There was a great number of those with the inherited factor (40%. It has been proven that the risk factors for the development of coronary artery disease are in direct association with the risk factors for the abdominal aortic aneurysm. Also, there is a great predominance of the coronary artery disease among the patients with aneurysm of the abdominal aorta. The coronary artery disease is one of the main risk factors. If we managed to prevent the appearance of this disease or achieve the timely diagnosing of it and eventual curing, we would be able to decrease the development of the abdominal aortic aneurysm well as the consequences and further complications.

  12. Noninvasive FFR derived from coronary CT angiography in the management of coronary artery disease: technology and clinical update

    Directory of Open Access Journals (Sweden)

    Nakanishi R

    2016-06-01

    Full Text Available Rine Nakanishi, Mathew J Budoff Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA Abstract: After a decade of clinical use of coronary computed tomographic angiography (CCTA to evaluate the anatomic severity of coronary artery disease, new methods of deriving functional information from CCTA have been developed. These methods utilize the anatomic information provided by CCTA in conjunction with computational fluid dynamics to calculate fractional flow reserve (FFR values from CCTA image data sets. Computed tomography-derived FFR (CT-FFR enables the identification of lesion-specific drop noninvasively. A three-dimensional CT-FFR modeling technique, which provides FFR values throughout the coronary tree (HeartFlow FFRCT analysis, has been validated against measured FFR and is now approved by the US Food and Drug Administration for clinical use. This technique requires off-site supercomputer analysis. More recently, a one-dimensional computational analysis technique (Siemens cFFR, which can be performed on on-site workstations, has been developed and is currently under investigation. This article reviews CT-FFR technology and clinical evidence for its use in stable patients with suspected coronary artery disease. Keywords: fractional flow reserve, coronary computed tomographic angiography, FFRCT, cFFR

  13. MR measurement of coronary arterial blood flow velocity. Evaluation of age, stenosis and drugs as factors affecting coronary blood flow

    International Nuclear Information System (INIS)

    Taoka, Yoshiaki; Harada, Masafumi; Nishitani, Hiromu; Yukinaka, Michiko; Nomura, Masahiro

    1998-01-01

    Coronary arterial blood flow velocity was measured using MRI. Two types of phase contrast methods were used for the measurements, one of which exhibited good resolving power whereas the other provided more distinct images acquired while the subject patients held their breath. Before measuring coronary arterial blood flow velocity, accuracy of the two phase contrast methods was evaluated using a phantom. The results obtained with both methods largely agreed with the values obtained using the phantom. Using both methods, the patterns of coronary arterial blood flow over one cardiac cycle were essentially identical. A peak was noted in late systole or in early diastole in the right coronary artery, whereas in the left coronary artery, a peak was noted somewhat later in diastole. In healthy volunteers, no significant difference in the maximal flow velocity in the coronary arteries was found from one age group to another. Among patients with coronary arterial stenosis, coronary arterial blood flow velocity central to the area of stenosis was lower than that observed in the healthy volunteers. Coronary arterial blood flow velocity was observed to decrease after administration of isosorbide dinitrate and increased following administration of nifedipine. (author)

  14. Anomalous Coronary Artery From the Opposite Sinus (ACAOS): Technical Challenges During Percutaneous Coronary Intervention.

    Science.gov (United States)

    Sinha, Santosh Kumar; Razi, Mahmodula; Mahrotra, Anupam; Aggarwal, Puneet; Singh, Anupam; Rekwal, Lokendra; Tripathi, Sunil; Abhishekh, Nishant Kumar; Krishna, Vinay

    2018-04-01

    Anomalies of the coronary arteries are reported in 1-2% of patients among diagnostic angiogram. Ectopic origin of right coronary artery (RCA) from opposite sinus is one of the most common and they are mainly benign, but at times may be malignant. We report a case of a 69-year-old male who underwent early invasive percutaneous coronary intervention for non-ST-segment elevation myocardial infarction (NSTEMI) where RCA arising from left sinus at the root of left main artery was culprit and various technical challenges were encountered while intervening in form of cannulation to tracking of hardwares. RCA was cannulated with floating wire technique using hockey stick guide catheter and revascularized by deployment of 3.5 × 38 mm Promus Premier Everolimus eluting stent (Boston Scientific, USA). To the best of our knowledge, this is the first ever report of ectopic RCA being revascularized by using hockey stick catheter.

  15. Severity of coronary artery disease in obese patients undergoing coronary angiography

    International Nuclear Information System (INIS)

    Javed, A.; Ali, J.; Kayani, A.M.

    2012-01-01

    Objective: To assess the relationship of severity of coronary artery disease with obesity in patients undergoing coronary angiography. Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC-NIHD), 1st February 2010 to 31st August 2010 Patients and Methods: The study population included 468 patients undergoing coronary angiography. Obesity was classified according to the BMI using the National Institutes of Health (NIH) criteria as normal (BMI 21-24 kg/m2), overweight (BMI 25-29 kg/m2), obesity class I (BMI 30-34 kg/m2), obesity class II (BMI 35 to 39 kg/m2 and obesity class III (BMI 40 or above kg/m2). Coronary angiography data were obtained from the Siemens Queries software system, which maintains the database including detailed angiographic findings of all patients at this institution. Significant lesions were defined as those with >70% diameter narrowing of coronary arteries (>50% for the left main coronary artery). We attempted to quantify the 'severity of CAD' by ascertaining the prevalence of High-Risk Coronary Anatomy (HRCA). Results: Insignificant difference was observed in traditional risk factors i.e. age, diabetes mellitus and smoking except hypertension and gender. Statistically significantly low prevalence of HRCA was encountered in the obese group (57.7%) as compared to normal/overweight group (75.8%) (p < 0.05). Conclusion: We conclude that obesity is associated with less severe coronary artery disease. (author)

  16. Quality of medical management in coronary artery disease.

    Science.gov (United States)

    Al Shammeri, Owayed; Stafford, Randall S; Alzenaidi, Ahlam; Al-Hutaly, Bushra; Abdulmonem, Alaa

    2014-01-01

    Patients with coronary artery disease (CAD) are at high risk of recurrent adverse cardiac events. Such risk can be diminished through a guideline-recommend optimal medical therapy (OMT), defined as adherence to appropriate antiplatelet therapy, lipid-lowering agents, beta-blockers and angio.tensin-converting enzyme inhibitors, blood pressure investment in strategies to achieve OMT in these high-risk patients.

  17. The coronary arteries of the agouti (Agouti paca, Linnaeus, 1766

    Directory of Open Access Journals (Sweden)

    Fabrício Singaretti de Oliveira

    2009-12-01

    Full Text Available The present study aimed to describe the coronary arteries in the agouti. Twelve hearts set, in a 10% formaldehyde aqueous solution, were used. The presence of left and right coronary arteries was observed in all hearts. The fi rst arose from the aorta, between the left auricle and the pulmonary trunk, and gave off into a circumfl ex branch, whichever was directed to the right surface of this viscerae, and an interventricular paraconal branch that went through the cardiac apex, on the left atrioventricular sulcus. In 91.6% of the cases, at its origin, the paraconal branch gave off a thick side branch to the left ventricle wall, and in 100% of the cases, went deep, characterizing a large myocardial bridge. In 8.4% of the cases, this thick side branch to the left ventricle wall originated directly from the left coronary artery and not from the paraconal branch, and alterations such those to the circumfl ex branch did not occur. Regarding the right coronary artery, the origin of this vessel was from the aorta, on the atrial surface, in the direction of the right ventricular border, going through the subsinuous interventricular sulcus as an interventricular subsinuous branch.

  18. Spontaneous coronary artery dissection. Case report and literature review

    DEFF Research Database (Denmark)

    Elming, H; Køber, L

    1999-01-01

    to patient characteristics, patient treatment, and prognosis. Primary spontaneous coronary artery dissection is a rare condition but one that must be considered when young people, especially post partum women, present an acute ischaemic syndrome. Thrombolytic therapy may be a two-edged sword and therefore...

  19. Change in patient nutritional knowledge following coronary artery ...

    African Journals Online (AJOL)

    Introduction: In order to reduce coronary artery disease (CAD) risk, moderate physical activity should be combined with other lifestyle modifications, such as proper nutrition, to have a dramatic impact. This necessitates educational and preventative measures, which should begin in childhood and continue throughout life.

  20. Hemangioma of the left coronary artery: Diagnosis and treatment

    International Nuclear Information System (INIS)

    Just, A.; Wiesmann, W.; Peters, P.E.; Haesfeld, M.; Sciuk, J.

    1992-01-01

    The authors describe the case of a histologically proven hemangioma in the left coronary artery of the left ventricle of a 24-year-old woman. The results of the different medical imaging methods applied are described and the treatment of cardiac angiomas is discussed. (orig.) [de

  1. Reduced glomerular filtration rate as a predictor of coronary artery ...

    African Journals Online (AJOL)

    Tarek A. Ghonemy

    2016-07-09

    Jul 9, 2016 ... Internal Medicine Department, Nephrology Unit, Zagazig University ... glomerular filtration rate (eGFR) and risk of coronary artery disease ... ing of eGFR may have a pivotal role in early detection and management of CAD in those types of ..... position statement from kidney disease improving global out-.

  2. Genetic epidemiology of coronary artery disease: an Asian Indian ...

    Indian Academy of Sciences (India)

    Coronary artery disease (CAD) has emerged as a major cause of morbidity and mortality worldwide. Recent findings on the role of genetic factors in the aetiopathology of CAD have implicated novel genes and variants in addition to those involved in lipid and lipoprotein metabolism. However, our present knowledge is ...

  3. Biochemical characterization of blood plasma of coronary artery ...

    Indian Academy of Sciences (India)

    This study aimed to investigate the biochemical profile of blood plasma of patients with coronary artery disease (CAD) and angiographically normal subjects (controls) to determine biomarkers for their differentiation. In this double blind study, 5 mL venous blood was drawn before angiography from CAD patients (n=60) and ...

  4. GST polymorphisms and early-onset coronary artery disease in ...

    African Journals Online (AJOL)

    Dysfunctional detoxification enzymes are responsible for prolonged exposure to reactive molecules and can contribute to endothelial damage, an underlying factor in coronary artery disease (CAD). Objectives. We aimed to assess 2 common polymorphic variant isoforms in GSTM1 and GSTP1 of GST in young CAD patients ...

  5. Sudden cardiac death and acute pathology of coronary arteries

    NARCIS (Netherlands)

    van Dantzig, J. M.; Becker, A. E.

    1986-01-01

    The pathology of sudden cardiac death still is a matter of controversy, particularly with respect to the state of the coronary arteries. A recent study has shown a high incidence of acute lesions and suggests a causal relationship. The present study has been designed to verify whether or not acute

  6. Factors Influencing Smoking Cessation in Patients with Coronary Artery Disease.

    Science.gov (United States)

    McKenna, Kryss; Higgins, Helen

    1997-01-01

    Ten sociodemographic, clinical, and psychological characteristics considered predictors of difficulty with smoking cessation in patients with coronary artery disease are reviewed. The compounding effects of nicotine addiction are discussed. Consideration of these factors may result in individualized programs for smoking cessation. A brief overview…

  7. Learning Style Preferences of Elderly Coronary Artery Disease Patients.

    Science.gov (United States)

    Theis, Saundra L.; Merritt, Sharon L.

    1992-01-01

    The Patient Learning Styles Questionnaire derived from Canfield and administered to 134 elderly coronary artery disease patients revealed the following order of learning preferences: structure, iconics, listening, direct experience, reading, achievement, affiliation, and eminence. Level of education significantly influenced preferred learning…

  8. Concomitant coronary artery revascularization and right pneumonectomy without cardiopulmonary bypass

    NARCIS (Netherlands)

    Hensens, AG; Zeebregts, C.J.A.M.; Liem, TH; Gehlmann, H; Lacquet, LK

    Combined coronary artery bypass grafting (CABG) and pneumonectomy has a high morbidity and mortality rate, especially when the right lung has to be removed. A patient is described who underwent a CABG operation through a midline sternotomy without the use of cardiopulmonary bypass (CPB), and a right

  9. Understanding gene expression in coronary artery disease through ...

    Indian Academy of Sciences (India)

    Understanding gene expression in coronary artery disease through global profiling, network analysis and independent validation of key candidate genes. Prathima ... Table 2. Differentially expressed genes in CAD compared to age and gender matched controls. .... Regulation of nuclear pre-mRNA domain containing 1A.

  10. CoViCAD : comprehensive visualization of coronary artery disease

    NARCIS (Netherlands)

    Temeer, M.; Olivan Bescos, J.; Breeuwer, M.; Vilanova, A.; Gerritsen, F.A.; Gröller, E.

    2007-01-01

    We present novel, comprehensive visualization techniques for the diagnosis of patients with Coronary Artery Disease using segmented cardiac MRI data. We extent an accepted medical visualization technique called the bull’s eye plot by removing discontinuities, preserving the volumetric nature of the

  11. Screening for anxiety disorders in patients with coronary artery disease

    NARCIS (Netherlands)

    Bunevicius, A.; Staniute, M.; Brozaitiene, J.; Pop, V.J.M.; Neverauskas, J.; Bunevicius, R.

    2013-01-01

    Background Anxiety disorders are prevalent and associated with poor prognosis in patients with coronary artery disease (CAD). However, studies examining screening of anxiety disorders in CAD patients are lacking. In the present study we evaluated the prevalence of anxiety disorders in patients with

  12. Understanding gene expression in coronary artery disease through ...

    Indian Academy of Sciences (India)

    Understanding gene expression in coronary artery disease through global profiling, network analysis ... A_33_P3249595 B-cell CLL/lymphoma 11A (zinc finger protein). BCL11A. 2.29 ..... It acts as a cytoplasmic sensor for viral infection and ...

  13. Diagnostic Value of Transthoracic Echocardiography in Patients With Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery

    Science.gov (United States)

    Li, Rong-Juan; Sun, Zhonghua; Yang, Jiao; Yang, Ya; Li, Yi-Jia; Leng, Zhao-Ting; Liu, Guo-Wen; Pu, Li-Hong

    2016-01-01

    Abstract Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary abnormality associated with early infant mortality and sudden death in adults. Transthoracic echocardiography (TTE) plays an important role in early detection and diagnosis of ALCAPA as a noninvasive modality. However, its diagnostic value is not well studied. The purpose of this study is to determine the performance of TTE in the diagnostic assessment of ALCAPA as compared with coronary CT and invasive coronary angiography. A total of 22 patients (13 women and 9 men, mean age, 12.9 ± 19.5 years) with ALCAPA who underwent echocardiographic examination for clinical diagnosis were retrospectively reviewed and analyzed. Transthoracic echocardiographic features of ALCAPA were analyzed and its diagnostic value was compared with invasive coronary angiography and coronary CT angiography (CTA) with surgical findings serving as the gold standard. Surgery was performed in all of the patients to establish the dual coronary artery system. Five underwent the Takeuchi procedure and 17 had re-implantation of the anomalous left coronary artery. Of 20 patients, echocardiographic diagnoses were in good agreement with findings at surgery, resulting in the diagnostic accuracy of 90.9%. Two cases were misdiagnosed—one as the right coronary artery to pulmonary artery fistula and the other as rheumatic heart disease. The echocardiographic features of these patients with ALCAPA included: abnormal left coronary ostium arising from the pulmonary trunk with retrograde coronary artery flow in 20 patients; enlargement of the right coronary artery in 17 patients; abundant intercoronary septal collaterals in 17 patients; and moderate and significant mitral regurgitation in 14 patients. The diagnostic accuracy of invasive coronary angiography (in 17 patients) and coronary CTA (in 9 patients) was 100%. This study shows that TTE is an accurate, noninvasive imaging modality

  14. Giant Coronary Artery Aneurysm Causing Acute Anterior Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Ahmet Yanık

    2016-01-01

    Full Text Available A 70-year-old man with hypertension was admitted to our coronary ICU with acute anterior MI. Emergent primary PCI was planned and coronary angiography was performed. LAD artery was totally occluded in the proximal segment just after a huge 32 × 26 mm sized aneurysm. Emergent CABG operation was performed in 75 minutes because of multivessel disease including the RCA and left circumflex artery. Aneurysm was ligated and coronary bypass was performed using LIMA and saphenous grafts. The postoperative course of the patient was uneventful. He was discharged with medical therapy including ASA, clopidogrel, and atorvastatin. He was asymptomatic at his polyclinic visit in the first month.

  15. Management standards for stable coronary artery disease in India

    Directory of Open Access Journals (Sweden)

    Sundeep Mishra

    2016-12-01

    Full Text Available Coronary artery disease (CAD is one of the important causes of cardiovascular morbidity and mortality globally, giving rise to more than 7 million deaths annually. An increasing burden of CAD in India is a major cause of concern with angina being the leading manifestation. Stable coronary artery disease (SCAD is characterised by episodes of transient central chest pain (angina pectoris, often triggered by exercise, emotion or other forms of stress, generally triggered by a reversible mismatch between myocardial oxygen demand and supply resulting in myocardial ischemia or hypoxia. A stabilised, frequently asymptomatic phase following an acute coronary syndrome (ACS is also classified as SCAD. This definition of SCAD also encompasses vasospastic and microvascular angina under the common umbrella.

  16. A case report of congenital coronary artery fistula to the left ventricle

    International Nuclear Information System (INIS)

    Lee, Byung Hee; Yu, Shi Joon; Moon, Eon Soo; Kim, Sam Hyun; Choi, Young Hi

    1987-01-01

    Congenital coronary artery fistula is a rare malformation with an incidence of 0.4% of congenital heart disease. Among the various subtypes, fistula to the left ventricle is extremely rare with 6 reported cases till 1983. We present a case of coronary artery fistula between the right coronary artery and the left ventricle. The dilated right coronary artery formed a mass like bulging the right lower heart border in the plain chest PA, we think this is first case with a coronary artery fistula to the left ventricle, reported in Korea

  17. Coronary arterial disease after electroconvulsive therapy: a case report

    Directory of Open Access Journals (Sweden)

    Nataly Pimentel Rodrigues

    2015-06-01

    Full Text Available Objectives Unipolar depression (UPD is a leading cause of global burden of diseases, particularly among the elderly, whose treatment may be challenging. In such cases, ECT is often recommended due to its safety and efficacy. This report presents a case of a 67-year-old male inpatient that developed a rare cardiac complication during ECT. Methods Clinical case report with patient’s consent and bibliographic review. Results A 67-year-old male inpatient with recurrent severe psychotic depression was hospitalized and ECT was indicated after failure of the pharmacological treatment. A comprehensive clinical pre-evaluation revealed only nonspecific ST-segment changes in electrocardiogram. During the 7th ECT session, it was observed transitory ST-segment depression followed by a discrete increase of plasma troponin I. Severe tri-vessel coronary artery stenosis was found and a percutaneous coronary angioplasty was performed, with satisfactory psychiatric and cardiac outcomes. Conclusions Unipolar depression (UPD and cardiovascular disease are often coexistent conditions, especially among the elderly. In the current case, myocardial ischemia was detected lately during ECT therapy and its treatment allowed the UPD treatment to be completed adequately.

  18. Anesthesia for off-pump coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Thomas M Hemmerling

    2013-01-01

    Full Text Available The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction of postoperative complications including systemic inflammation, myocardial injury, and cerebral injury. Minimally invasive surgery for single vessel OPCAB through a limited thoracotomy incision can offer the advantage of further reduction of complications. The anesthesiologist has to deal with different issues, including hemodynamic instability and myocardial ischemia during aorto-coronary bypass grafting. The anesthesiologist and surgeon should collaborate and plan the best perioperative strategy to provide optimal care and ensure a rapid and complete recovery. The use of high thoracic epidural analgesia and fast-track anesthesia offers particular benefits in beating heart surgery. The excellent analgesia, the ability to reduce myocardial oxygen consumption, and the good hemodynamic stability make high thoracic epidural analgesia an interesting technique. New scenarios are entering in cardiac anesthesia: ultra-fast-track anesthesia with extubation in the operating room and awake surgery tend to be less invasive, but can only be performed on selected patients.

  19. The relationship between coronary stenosis severity and compression type coronary artery movement in acute myocardial infarction.

    Science.gov (United States)

    Chan, Kim H; Chawantanpipat, Chirapan; Gattorna, Tim; Chantadansuwan, Thamarath; Kirby, Adrienne; Madden, Ann; Keech, Anthony; Ng, Martin K C

    2010-04-01

    Acute myocardial infarction is thought to occur at sites of minor coronary stenosis. Recent data challenge this and also propose a role for coronary artery movement (CAM) in plaque instability. We examined the relationship between coronary stenosis severity, CAM pattern, and infarct-related lesions (IRLs) in acute myocardial infarction. We investigated 203 consecutive patients with ST-segment elevation myocardial infarction after successful fibrinolysis. Quantitative coronary angiography, CAM pattern, and extent score (atheroma burden) analysis was performed for each coronary artery segment. The IRL stenosis was at least moderate (>50%) and severe (>70%) in 78% and 31% of patients, respectively. Culprit arteries were associated with higher atheroma extent scores (25.2 vs 21.6, P 70% vs Compression CAM was also strongly associated with culprit segments (OR 3.4, 95% CI 2.6-4.5, P compression CAM and stenosis severity were strongly correlated, with the likelihood of a coronary segment having compression CAM progressively increasing with worsening stenosis (OR 56.4, 95% CI 37.9-83.8, P 70% vs relationship between stenosis severity and IRLs. Our study also raises the hypothesis that compression CAM may accelerate atherosclerosis and predispose to plaque vulnerability. Copyright 2010 Mosby, Inc. All rights reserved.

  20. Characterization of the contractile P2Y14 receptor in mouse coronary and cerebral arteries

    DEFF Research Database (Denmark)

    Haanes, Kristian Agmund; Edvinsson, Lars

    2014-01-01

    values and immunohistochemistry illustrated the strongest P2Y14 receptor expression in the basilar artery. In the presence of pertussis toxin, UDP-glucose inhibited contraction in coronary arteries and in the basilar artery it surprisingly caused relaxation. After organ culture of the coronary artery...

  1. Evaluation of the restenosis of coronary artery after percutaneous transluminal coronary angioplasty by three-dimensional coronary magnetic resonance angiography

    International Nuclear Information System (INIS)

    Arisaka, Hiraku

    2000-01-01

    Coronary magnetic resonance angiography (MRA) has been recently brought into clinical use, however, there has not been reports on the comparison with MRA and conventional contrast coronary angiography (CAG) in the detection of the localization and characteristics of coronary restenosis after percutaneous transluminal coronary angioplasty (PTCA). To assess the restenosis of coronary artery after PTCA, this study compared three-dimensional (3D) coronary MRA and CAG. One hundred three patients (76 males and 27 females, average age of 64.6±9.3 years old) were performed coronary MRA at 3-6 months after PTCA. The right coronary artery (RCA) group consist of 21 patients, the left anterior descending branch (LAD) 63 patients and the left circumflex branch (LCX) 19 patients. Coronary MRA was performed with the patients in supine position on a 1.5 T whole body scanner (MAGNETOM VISION, Siemens AG, Germany) using body array coil. The imaging technique used a 3-D gradient echo sequence with respiratory gating and fat suppression. The slice thickness was 2 mm, slab thickness 32 mm, a field of view of 300 mm and a matrix of 128 x 256. Other parameters were an echo time of 2.7 ms and a repetition time of 600 to 1100 msec. The measurement time of 1 imaging slab took 15 to 20 minutes depending on the patient's heart rate. The coronary arteries were reconstructed from the 3-D data set using a multiplanar reconstruction (MPR) technique. According to previous coronary MRA studies, a significant stenosis with a luminal reduction of ≥50% was assumed if a marked signal reduction or signal loss of a vessel segment was visible. In CAG, 57 of 103 patients showed restenosis. In coronary MRA, 37 of 103 patients demonstrated restenosis. The sensitivity, specificity, positive and negative predictive values were 64.9%, 100%, 100% and 69.6%, respectively. Predictive accuracy was 79.6%. Three-dimensional coronary MRA is useful in a noninvasive diagnostic method to evaluate the coronary

  2. Coronary artery disease risk in young women with polycystic ovary syndrome.

    Science.gov (United States)

    Ding, Dah-Ching; Tsai, I-Ju; Wang, Jen-Hung; Lin, Shinn-Zong; Sung, Fung-Chang

    2018-02-02

    Women with polycystic ovary syndrome are characterized by obesity, menstruation irregularity, hirsutism and infertility, and prevalent with cardiometabolic comorbidities, but population-based studies on the risk of developing coronary artery disease are limited. From claims data of the Taiwan National Health Insurance, we identified 8048 women with polycystic ovary syndrome aged 15-49 years newly diagnosed in 1998-2013, and 32192 women without the syndrome and CAD as controls, frequency matched by age and diagnosis date. By the end of 2013, after a mean follow-up period of 5.9 years, the overall incidence of coronary artery disease was 63% higher in women with polycystic ovary syndrome than in controls (2.25 vs. 1.38 per 1000 person-years). The adjusted hazard ratio [aHR] of coronary artery disease was 1.44 (95% confidence interval (CI) = 1.14-1.81) for women with polycystic ovary syndrome, compared with controls. Hazards of coronary artery disease were significant during follow-up periods of 3-4 years (aHR = 1.52, 95% CI = 1.00-2.30) and of 5-9 years (aHR = 1.58, 95% CI = 1.07-2.32). The incidence of coronary artery disease increased further in those with cardiometabolic comorbidities. Among women with polycystic ovary syndrome, those with comorbid diabetes had an incidence of 35.2 per 1000 person-years, 20-fold greater than those without cardiometabolic comorbidities. In conclusion, women with polycystic ovary syndrome are at an elevated risk of coronary artery disease. Preventive interventions should be provided to them, particularly for those with the comorbidity of metabolism symptom.

  3. The association of surgical versus natural menopause with future left ventricular structure and function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

    Science.gov (United States)

    Appiah, Duke; Schreiner, Pamela J; Nwabuo, Chike C; Wellons, Melissa F; Lewis, Cora E; Lima, Joao A

    2017-11-01

    To evaluate the association between surgical menopause (SM) versus natural menopause (NM) in relation to later left ventricular (LV) structure and function, while taking into account the LV parameters and other cardiovascular disease risk factor (CVDRF) levels that predate the menopausal transition. We studied 825 premenopausal women from the Coronary Artery Risk Development in Young Adults study in 1990 to 1991 (baseline, mean age 32 years) who later reached menopause by 2010 to 2011 and had echocardiograms at these two time points. During 20 years of follow-up, 508 women reached NM, whereas 317 underwent SM (34% had bilateral oophorectomy). At baseline, women who later underwent SM were more likely to be black, younger, have greater parity, and higher mean values of systolic blood pressure, body mass index, and also lower mean high-density lipoprotein cholesterol and physical activity than women who reached NM. No significant differences in LV structure/function were found between groups. In 2010 to 2011, SM women had significantly higher LV mass, LV mass/volume ratio, E/e' ratio, and impaired longitudinal and circumferential strain than NM women. SM women with bilateral oophorectomy had adverse LV measures than women with hysterectomy with ovarian conservation. Controlling for baseline echocardiographic parameters and CVDRF in linear regression models eliminated these differences between groups. Further adjustment for age at menopause/surgery and hormone therapy use did not change these results. In this study, the adverse LV structure and function observed among women with SM compared with NM were explained by their unfavorable presurgical CVDRF profiles, suggesting that premenopausal CVDRF rather than gynecologic surgery predispose SM women to elevated future cardiovascular disease risk.

  4. Intracranial cerebral artery stenosis with associated coronary artery and extracranial carotid artery stenosis in Turkish patients

    Energy Technology Data Exchange (ETDEWEB)

    Alkan, Ozlem [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey)], E-mail: yalinozlem@hotmail.com; Kizilkilic, Osman; Yildirim, Tulin [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey); Atalay, Hakan [Department of Cardiovascular Surgery, Baskent University, Faculty of Medicine, Ankara (Turkey)

    2009-09-15

    Purpose: Although it has been demonstrated that there is a high prevalence of extracranial carotid artery stenosis (ECAS) in patients with severe coronary artery disease, intracranial cerebral artery stenosis (ICAS) is rarely mentioned. We evaluated the prevalence of ICAS in patients with ECAS having elective coronary artery bypass grafting (CABG) surgery to determine the relations between ICAS, ECAS and atherosclerotic risk factors. Methods: We retrospectively reviewed the digital subtraction angiography findings of 183 patients with ECAS {>=} 50% preparing for CABG surgery. The analyses focused on the intracranial or extracranial location and degree of the stenosis. The degree of extracranial stenoses were categorized as normal, <50%, 50-69%, 70-89%, and 90-99% stenosis and occluded. The degree of intracranial stenosis was classified as normal or {<=}25%, 25-49%, and {>=}50% stenosis and occluded. Traditional atherosclerotic risk factors were recorded. Results: ECAS < 70% in 42 patients and ECAS {>=} 70% in 141 patients. ICAS was found in 51 patients and ICAS {>=} 50% in 30 patients. Regarding risk factors, we found hypertension in 135 patients, diabetes mellitus in 91 patients, hyperlipidemia in 84 patients, and smoking in 81 patients. No risk factor was significant predictors of intracranial atherosclerosis. The severity of ICAS was not significantly associated with that of the ECAS. Conclusions: We found ICAS in 27.8% of the patients with ECAS > 50% on digital subtraction angiography preparing for CABG. Therefore a complete evaluation of the neck vessels with magnetic resonance or catheter angiography seems to be indicated as well as intracranial circulation for the risk assessment of CABG.

  5. YKL-40 a new biomarker in patients with acute coronary syndrome or stable coronary artery disease

    DEFF Research Database (Denmark)

    Wang, Y.Z.; Ripa, R.S.; Johansen, J.S.

    2008-01-01

    Background. YKL-40 is involved in remodelling and angiogenesis in non-cardiac inflammatory diseases. Aim was to quantitate plasma YKL-40 in patients with ST-elevation myocardial infarction (STEMI) or stable chronic coronary artery disease (CAD), and YKL-40 gene activation in human myocardium....... Methods and results. We included 73 patients: I) 20 patients with STEMI; II) 28 patients with stable CAD; III) 15 CAD patients referred for coronary by-pass surgery. YKL-40 mRNA expression was measured in myocardium subtended by stenotic or occluded arteries and areas with no apparent disease; and IV) 10...

  6. Thallium-201 myocardial imaging in young adults with anomalous left coronary artery arising from the pulmonary artery

    International Nuclear Information System (INIS)

    Moodie, D.S.; Cook, S.A.; Gill, C.C.; Napoli, C.A.

    1980-01-01

    Anomalous origin of the left coronary artery from the pulmonary artery (Bland-Garland-White syndrome) may produce myocardial ischemia, infarction, and frequently death in infancy. Some patients, however, develop satisfactory coronary artery collaterals and are relatively asymptomatic into adulthood. Very little is known about their myocardial perfusion patterns. We studied three young adults with this condition using stress thallium-201 myocardial imaging. Electrocardiograms in two patients demonstrated old arterolateral myocardial infarctions. Preoperative stress exercise tests were positive in all three patients. Marked perfusion abnormalities were found in the proximal anterolateral wall in all patients, and one patient also had a posterolateral defect. Postoperatively, all stress tests returned to normal. Thallium imaging demonstrated improvement in ischemic areas, but old scars persisted

  7. Ulnar artery: The Ulysses ultimate resort for coronary procedures

    Directory of Open Access Journals (Sweden)

    George Hahalis, MD, PhD

    2016-07-01

    Full Text Available Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA. Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.

  8. Ulnar artery: The Ulysses ultimate resort for coronary procedures.

    Science.gov (United States)

    Hahalis, George; Deftereos, Spyridon; Bertrand, Olivier F

    2016-08-20

    Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates. Copyright © 2016 Hellenic Cardiological Society. Published by Elsevier B.V. All rights reserved.

  9. Prevalence of Congenital Coronary Artery Anomalies and Variants in 2697 Consecutive Patients Using 64-Detector Row Coronary CTAngiography

    International Nuclear Information System (INIS)

    Shabestari, Abbas Arjmand; Akhlaghpoor, Shahram; Tayebivaljozi, Reza; Fattahi Masrour, Farzaneh

    2012-01-01

    Coronary artery anomalies are not common, but could be very serious. This study determines the frequency of coronary anomalies and normal variants by multi-detector-row computed tomography (MDCT). The results of cardiac MDCT study in 2697 consecutive patients were analyzed retrospectively. Acquisition was performed by a 64-detector row CT machine. Imaging results were assessed by experienced radiologists. Myocardial bridging was by far the most frequent coronary variant (n = 576, 21.3%). Eighty-three subjects (3.1%) showed other coronary anomalies and variants. Anomalies of origination and course of the left main coronary artery (LMCA) were detected in 1.09% of the subjects. The frequency of these anomalies in the right coronary artery (RCA), left circumflex artery (LCx), left anterior descending artery (LAD), posterior descending artery (PDA) and obtuse marginal (OM) artery were 1.24%, 0.33%, 0.1%, 0.07% and 0.03%, respectively. The single coronary pattern was seen in 0.18% and coronary fistulas in 0.07%. Based on the fact that coronary CT-angiography using MDCT can display different coronary anomalies, this study shows similar results to other reports on the subject. Future advances in the performance of CT machines will further improve the quality of CT-based cardiac imaging

  10. Percutaneous brachial artery catheterization for coronary angiography and percutaneous coronary interventions (pci): an encouraging experience of 100 cases

    International Nuclear Information System (INIS)

    Islam, Z.U.; Maken, G.R.; Saif, M.; Khattak, Z.A.

    2013-01-01

    Objective: To evaluate the practicability and safety of the percutaneous transbrachial approach (TBA) for diagnostic coronary angiography and therapeutic percutaneous coronary interventions. Study Design: Quasi experimental study. Place and Duration of Study: The study was carried out in Armed Forces Institute of Cardiology- National Institute of Heart Diseases (AFIC-NIHD) from March 2009 to May 2011. Patients and Methods: We collected data of 100 consecutive patients who underwent coronary catheterization by the percutaneous transbrachial approach. Transbrachial catheterization was performed only if the radial access failed or radial pulse was feeble. Study endpoints included successful brachial artery catheterization, vascular and neurological complications at access site and procedure success rate. Results: Mean age of the patients was 54 years (range 33-79 yrs) and 65(65%) were males and 35 (35%) were females. The right brachial artery was used in all of the cases. Procedural success was achieved in 100% of the patients. Coronary angiography was performed in 70 patients and percutaneous coronary interventions were done in 30 cases. Out of these 30 cases, PCI to left coronary arteries (LAD and LCX) were performed in 19 patients while 11 patients had PCI to right coronary artery (RCA). No case of vascular complications such as major access site bleeding, vascular perforation, brachial artery occlusion causing forearm ischemia, compartment syndrome, vascular spasm or failure to catheterize coronary arteries requiring alternate vascular access were observed. Conclusion: Brachial artery is a safe and easily accessible approach for coronary angiography and percutaneous coronary interventions. (author)

  11. Role of coronary physiology in the contemporary management of coronary artery disease

    Science.gov (United States)

    Ruparelia, Neil; Kharbanda, Rajesh K

    2015-01-01

    Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually “intermediate” in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications. PMID

  12. Role of coronary physiology in the contemporary management of coronary artery disease.

    Science.gov (United States)

    Ruparelia, Neil; Kharbanda, Rajesh K

    2015-02-16

    Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually "intermediate" in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications.

  13. Value of magnetic resonance imaging for the noninvasive detection of stenosis in coronary artery bypass grafts and recipient coronary arteries

    NARCIS (Netherlands)

    Langerak, Susan E.; Vliegen, Hubert W.; Jukema, J. Wouter; Kunz, Patrik; Zwinderman, Aeilko H.; Lamb, Hildo J.; van der Wall, Ernst E.; de Roos, Albert

    2003-01-01

    BACKGROUND: Magnetic resonance imaging (MRI) is a potential noninvasive diagnostic tool to detect coronary artery bypass graft stenosis, but its value in clinical practice remains to be established. We investigated the value of MRI in detecting stenotic grafts, including recipient vessels. METHODS

  14. Functional Information in Coronary Artery Disease

    DEFF Research Database (Denmark)

    Kofoed, Klaus F; Sørgaard, Mathias H; Linde, Jesper J

    2017-01-01

    as an add-on to standard coronary CT angiography (CCTA), to identify regions of myocardial hypoperfusion, at rest and during adenosine stress. The principle of measurement is well-validated in animal experimental models, and CT myocardial perfusion imaging has a high degree of concordance with already...

  15. Relationship between homocysteine and coronary artery disease. Results from a large prospective cohort study

    NARCIS (Netherlands)

    Schaffer, A.; Verdoia, M.; Cassetti, E.; Marino, P.; Suryapranata, H.; Luca, G. De

    2014-01-01

    BACKGROUND: Coronary artery disease (CAD) still represents the major cause of mortality in developed countries. Large research programs have been focused on the identification of new risk factors to prevent CAD, with special attention to homocysteine (Hcy), due to the known associated increased

  16. Congenital anomalies of coronary arteries: Diagnosis with 64 slice multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Tariq, Rukhsana, E-mail: drrukhsanatariq@hotmail.com [Consultant Radiologists, Advanced Radiology Clinic, Behind Hamdard University Hospital, Off M.A. Jinnah Road, Karachi (Pakistan); Kureshi, Shahzad Babar [Consultant Radiologists, Advanced Radiology Clinic, Behind Hamdard University Hospital, Off M.A. Jinnah Road, Karachi (Pakistan); Siddiqui, Usman T. [Medical College, Aga Khan University, Karachi (Pakistan); Ahmed, Rashid [Consultant Radiologists, Advanced Radiology Clinic, Behind Hamdard University Hospital, Off M.A. Jinnah Road, Karachi (Pakistan)

    2012-08-15

    Objective: Congenital coronary artery anomalies are generally incidental, uncommon and asymptomatic. Some can cause severe potentially life threatening symptoms. The common mode of studying the coronary arteries is Conventional Coronary Angiogram. ECG-gated-multidetector CT is a non invasive modality. The objective of our study was to identify rare congenital coronary artery anomalies and discuss their clinical significance. Material and methods: A total number of 900 MDCT coronary angiograms were carried out at our institution between the period of April 2006 and October 2010. Patients with coronary artery anomaly constituted the subject of study. Results: The incidence of anomalous anatomical origin and course of the coronary arteries in our study was 1.55%. Hemodynamical significance was seen in five patients. 3 cases of single coronary artery originating from right coronary sinus were seen. 1 case of anomalous left coronary artery arising from main pulmonary artery was seen. 4 cases of anomalous RCA arising from left aortic cusp, 6 cases of absent LMCA with separate origin of LAD and LCX were seen. Conclusion: Multidetector row CT is a noninvasive modality in cardiac imaging. It provides superior resolution of coronary tree and its variant. No projectional vascular overlap is seen. Various postprocessing techniques outclass catheter angiography imaging. Definition of ostia and proximal course of the coronary arteries by Multidetector CT is better than catheter angiography.

  17. Congenital anomalies of coronary arteries: Diagnosis with 64 slice multidetector CT

    International Nuclear Information System (INIS)

    Tariq, Rukhsana; Kureshi, Shahzad Babar; Siddiqui, Usman T.; Ahmed, Rashid

    2012-01-01

    Objective: Congenital coronary artery anomalies are generally incidental, uncommon and asymptomatic. Some can cause severe potentially life threatening symptoms. The common mode of studying the coronary arteries is Conventional Coronary Angiogram. ECG-gated-multidetector CT is a non invasive modality. The objective of our study was to identify rare congenital coronary artery anomalies and discuss their clinical significance. Material and methods: A total number of 900 MDCT coronary angiograms were carried out at our institution between the period of April 2006 and October 2010. Patients with coronary artery anomaly constituted the subject of study. Results: The incidence of anomalous anatomical origin and course of the coronary arteries in our study was 1.55%. Hemodynamical significance was seen in five patients. 3 cases of single coronary artery originating from right coronary sinus were seen. 1 case of anomalous left coronary artery arising from main pulmonary artery was seen. 4 cases of anomalous RCA arising from left aortic cusp, 6 cases of absent LMCA with separate origin of LAD and LCX were seen. Conclusion: Multidetector row CT is a noninvasive modality in cardiac imaging. It provides superior resolution of coronary tree and its variant. No projectional vascular overlap is seen. Various postprocessing techniques outclass catheter angiography imaging. Definition of ostia and proximal course of the coronary arteries by Multidetector CT is better than catheter angiography.

  18. Anatomy of right superior septal artery demonstrated on the coronary CT scan

    International Nuclear Information System (INIS)

    Takeguchi, Takaya; Ibukuro, Kenji; Fukuda, Hozumi; Tobe, Kimiko; Abe, Shoko

    2012-01-01

    Background. A coronary CT scan allows for non-invasive visualization of the anatomy of a coronary artery in three dimensions compared to the two dimensions afforded by conventional angiography. The septal artery, the main blood source of the interventricular septum, is usually derived from the left anterior descending artery; however, it is occasionally derived from the right coronary artery. Purpose. To analyze the prevalence, origin, diameter, and length of the right superior septal artery (RSSA) demonstrated on a coronary CT scan. Material and Methods. The right superior septal artery was retrospectively reviewed on the reconstructed axial scan images (0.5-mm thickness, 0.25-mm interval) in 1290 consecutive patients who underwent coronary CT scans. All patients were scanned on a 320-row CT scanner. The images were transferred to a workstation to trace the vessel to analyze the origin, diameter, and length. We also compared the length of the RSSA between patients with and without coronary artery stenosis. Results. The RSSA was identified in 51 (3.9%) of 1290 patients. The origin was the proximal portion of the right coronary artery (n = 40) or the right sinus of Valsalva (n 11). The artery co-existed with the conus artery in 15 (29%) of 51 patients. The length was 16-62 mm (mean 31.2 mm ± 10.5), and the diameter was 0.8-2.0 mm (mean 1.3 mm ± 0.2). Longer RSSAs tended to be demonstrated in the patients with coronary artery stenosis rather than with normal coronary arteries (P < 0.05). Conclusion. The right superior septal artery and its anatomical variant could be analyzed with a coronary CT scan. The ability to demonstrate this artery on the coronary CT scan was the same as with coronary angiography. The recognition of this vessel is useful for physicians managing with the diagnosis and treatment of the coronary artery disease

  19. Anatomy of right superior septal artery demonstrated on the coronary CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Takeguchi, Takaya (Mitsui Memorial Hospital, Department of Diagnostic Radiology, Tokyo (Japan); Tokyo Medical and Dental University, Department of Diagnostic Radiology, Tokyo (Japan)); Ibukuro, Kenji; Fukuda, Hozumi; Tobe, Kimiko; Abe, Shoko (Mitsui Memorial Hospital, Department of Diagnostic Radiology, Tokyo (Japan)), Email: kj-ibkr@qd6.so-net.ne.jp

    2012-02-15

    Background. A coronary CT scan allows for non-invasive visualization of the anatomy of a coronary artery in three dimensions compared to the two dimensions afforded by conventional angiography. The septal artery, the main blood source of the interventricular septum, is usually derived from the left anterior descending artery; however, it is occasionally derived from the right coronary artery. Purpose. To analyze the prevalence, origin, diameter, and length of the right superior septal artery (RSSA) demonstrated on a coronary CT scan. Material and Methods. The right superior septal artery was retrospectively reviewed on the reconstructed axial scan images (0.5-mm thickness, 0.25-mm interval) in 1290 consecutive patients who underwent coronary CT scans. All patients were scanned on a 320-row CT scanner. The images were transferred to a workstation to trace the vessel to analyze the origin, diameter, and length. We also compared the length of the RSSA between patients with and without coronary artery stenosis. Results. The RSSA was identified in 51 (3.9%) of 1290 patients. The origin was the proximal portion of the right coronary artery (n = 40) or the right sinus of Valsalva (n 11). The artery co-existed with the conus artery in 15 (29%) of 51 patients. The length was 16-62 mm (mean 31.2 mm +- 10.5), and the diameter was 0.8-2.0 mm (mean 1.3 mm +- 0.2). Longer RSSAs tended to be demonstrated in the patients with coronary artery stenosis rather than with normal coronary arteries (P < 0.05). Conclusion. The right superior septal artery and its anatomical variant could be analyzed with a coronary CT scan. The ability to demonstrate this artery on the coronary CT scan was the same as with coronary angiography. The recognition of this vessel is useful for physicians managing with the diagnosis and treatment of the coronary artery disease

  20. IS LIPOPROTEIN (A A PREDICTOR OF CORONARY ARTERY DISEASE SEVERITY?

    Directory of Open Access Journals (Sweden)

    Tayyebeh Miandoabi

    2010-12-01

    Full Text Available Abstract    INTRODUCTION: Studies on the association between the plasma concentration of lipoprotein (a and coronary heart disease (CHD have reported conflicting findings.    METHOD AND MATERIALS: The objective of the present study was to evaluate the association between serum levels of lipoprotein (a and ischemic heart disease as well as other cardiovascular risk factors in a population-based study. Lipoprotein (a serum was measured in 142 patients with chronic stable angina undergoing clinically indicated coronary angiography. Lipid profile, fasting blood glucose, anthropometric and clinical parameters were analyzed.    RESULTS: Lipoprotein (a levels were significantly associated with coronary artery stenosis in men, but not in women. Also, an direct association between mean levels of lipoprotein (a and coronary artery stenosis in men younger than 55 years old and an inverse association in men older than 55 years old were observed.     CONCLUSION: Multivariate analysis revealed that lipoprotein (a was considered an independent predictor for severity of CAD in men, especially in younger ages.      Keywords: Lipoprotein (a, cardiovascular risk factors, Ischemic heart disease, coronary angiography.

  1. Radial artery approach for coronary intervention - early experience

    International Nuclear Information System (INIS)

    Jan, H.; Hadi, A.; Fahim, M.; Gul, A.M.; Irfan, M.; Khan, S.B.; Hafizullah, M.

    2012-01-01

    Objective: To see the clinical outcome of patients undergoing Transradial Coronary Angioplasty with stable Angina. Methodology: This was a single center observational study with prospective data collection of 338 patients who underwent transradial coronary angioplasty from September 2009 to August 2011, at Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. Patients of both genders and all ages who had transradial coronary angioplasty for chronic stable angina were included in the study. Patients were clinically examined in out patients department on first month of hospital discharge and clinical outcome data was recorded. Results: A total of 338 patients were included in the study. Male were 58.8% and 41.2% were female with mean age of 52+-7 years. All the patients had coronary intervention through right radial artery. Baseline characteristics of the patients were; 48.2% diabetic, 43.2% hypertensive, 30.5% smokers, dyslipidemia was 45.7% and mean values of serum creatinine and Hemoglobin were 1.1+-0.3 and 11.5+-1.5, respectively. The frequency of various complications were as follow; hematoma 1.3%, nausea and vomiting 2.2%, pain in hand 11.2%, re admission to hospital for chest pain 6.5%, need for revascularization 2.2%, hand ischemia 1.8%, minor bleeding 0.9%, no major bleeding and 1.9% mortality. Conclusion: The radial artery approach for coronary intervention is useful with low degree of access site vascular complications and an early mobilization. (author)

  2. Radial artery approach for coronary intervention - early experience

    Energy Technology Data Exchange (ETDEWEB)

    Jan, H; Hadi, A; Fahim, M; Gul, A M; Irfan, M; Khan, S B; Hafizullah, M [Lady Reading Hospital and Khyber Medical University, Peshawar (Pakistan). Dept. of Cardiology

    2012-01-15

    Objective: To see the clinical outcome of patients undergoing Transradial Coronary Angioplasty with stable Angina. Methodology: This was a single center observational study with prospective data collection of 338 patients who underwent transradial coronary angioplasty from September 2009 to August 2011, at Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. Patients of both genders and all ages who had transradial coronary angioplasty for chronic stable angina were included in the study. Patients were clinically examined in out patients department on first month of hospital discharge and clinical outcome data was recorded. Results: A total of 338 patients were included in the study. Male were 58.8% and 41.2% were female with mean age of 52+-7 years. All the patients had coronary intervention through right radial artery. Baseline characteristics of the patients were; 48.2% diabetic, 43.2% hypertensive, 30.5% smokers, dyslipidemia was 45.7% and mean values of serum creatinine and Hemoglobin were 1.1+-0.3 and 11.5+-1.5, respectively. The frequency of various complications were as follow; hematoma 1.3%, nausea and vomiting 2.2%, pain in hand 11.2%, re admission to hospital for chest pain 6.5%, need for revascularization 2.2%, hand ischemia 1.8%, minor bleeding 0.9%, no major bleeding and 1.9% mortality. Conclusion: The radial artery approach for coronary intervention is useful with low degree of access site vascular complications and an early mobilization. (author)

  3. Relationship between Renal Artery Stenosis and Severity of Coronary Artery Disease in Patients with Coronary Atherosclerotic Disease

    Directory of Open Access Journals (Sweden)

    Amirfarhang Zandparsa

    2012-09-01

    Full Text Available Objective: The aim of the present investigation was to explore probable association of renal artery stenosis (RAS with coronary artery disease (CAD and the prevalence of renal artery stenosis (RAS in patients with CAD. Patients and methods: This study comprised 165 consecutive patients with CAD, including 52.7% males and 47.2% females with respective mean ages of 60.3 ±8.9 and 59.5±10.1. The patients underwent simultaneous coronary and renal angiographies, and the lumen reduction of 50% or more was considered as significant stenosis. Indeed, stenosis of more than 70% of the arterial lumen was regarded as severe. Results: According to our findings, the prevalence of renal artery stenosis in our hypertensive and normotensive patients were 46.2% and 19.5% respectively (p=0.002. Renal artery angiography revealed that 64 (38.8% of the patients had simultaneous renal artery stenosis. RAS is more common in females than males (p=0.031. Multivariate analysis revealed that among all examined factors, hypertension and serum creatinine were associated with RAS. There was no correlations found between gensini score and RAS (p=0.63. Conclusion: We found a relatively high prevalence of RAS including 46.2% in hypertensive and 19.5% in normotensive patients in our patients with CAD.

  4. Myocardial perfusion SPECT in a case of retropulmonary looping of left coronary artery in a baby after arterial switch surgery

    International Nuclear Information System (INIS)

    Padma, Subramanyam; Sundaram, Palaniswamy Shanmuga

    2014-01-01

    Pediatric myocardial perfusion imaging (MPI) is not a routine investigation in an Indian setting due to under referrals and logistic problems. However, MPI is a frequently performed and established modality of investigation in adults for the identification of myocardial ischemia and viability. We report myocardial perfusion scintigraphy in a case of retropulmonary looping of left coronary artery in a baby after arterial switch surgery. Adenosine stress MPI revealed a large infarct involving anterior segment with moderate reversible ischemia of the lateral left ventricular segment. Coronary angiogram later confirmed left main coronary artery ostial occlusion with retrograde collateral supply from dilated right coronary artery

  5. Value of multiple risk factors in predicting coronary artery disease

    International Nuclear Information System (INIS)

    Zhu Zhengbin; Zhang Ruiyan; Zhang Qi; Yang Zhenkun; Hu Jian; Zhang Jiansheng; Shen Weifeng

    2008-01-01

    Objective: This study sought to assess the relationship between correlative comprehension risk factors and coronary arterial disease and to build up a simple mathematical model to evaluate the extension of coronary artery lesion in patients with stable angina. Methods: A total of 1024 patients with chest pain who underwent coronary angiography were divided into CAD group(n=625)and control group(n=399) based on at least one significant coronary artery narrowing more than 50% in diameter. Independent risk factors for CAD were evaluated and multivariate logistic regression model and receiver-operating characteristic(ROC) curves were used to estimate the independent influence factor for CAD and built up a simple formula for clinical use. Results: Multivariate regression analysis revealed that UACR > 7.25 μg/mg(OR=3.6; 95% CI 2.6-4.9; P 20 mmol/L(OR=3.2; 95% CI 2.3-4.4; P 2 (OR=2.3; 95% CI 1.4-3.8; P 2.6 mmol/L (OR 2.141; 95% CI 1.586-2.890; P 7.25 μg/mg + 1.158 x hsCRP > 20 mmol/L + 0.891 GFR 2 + 0.831 x LVEF 2.6 mmol/L + 0.676 x smoking history + 0.594 x male + 0.459 x diabetes + 0.425 x hypertension). Area under the curve was 0.811 (P < 0.01), and the optimal probability value for predicting severe stage of CAD was 0.977 (sensitivity 49.0%, specificity 92.7% ). Conclusions: Risk factors including renal insufficiency were the main predictors for CAD. The logistic regression model is the non-invasive method of choice for predicting the extension of coronary artery lesion in patients with stable agiana. (authors)

  6. Endoscopic Radial Artery Harvest for Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Kuan-Ming Chiu

    2006-01-01

    Conclusion: Endoscopic harvest of the radial artery is technically demanding, but excellent results can be achieved. The endoscopic approach can provide suitable conduits in a less invasive way than the open harvest technique.

  7. CT Coronary Angiography vs. Coronary Artery Calcium Scoring for the Occupational Assessment of Military Aircrew.

    Science.gov (United States)

    Parsons, Iain; Pavitt, Chris; Chamley, Rebecca; d'Arcy, Jo; Nicol, Ed

    2017-02-01

    To ensure flight safety military aircrew undergo regular clinical and occupational assessment. Coronary artery calcium scoring (CACS) has been established as an imaging modality to noninvasively assess coronary artery disease (CAD). CT coronary angiography (CTCA) potentially offers a more accurate assessment of CAD, but has not been formally assessed in military aircrew. This retrospective cohort study is designed to compare the theoretical differences in downstream investigations and occupational outcomes in aircrew with suspected CAD comparing CTCA with existing CACS pathways. A 2-yr retrospective cohort study of consecutive UK military patients who underwent a CTCA and CACS was undertaken. Patient demographics, CTCA and CACS results, and initial and final occupational restrictions were analyzed comparing current UK, Canadian, and U.S. pathways. There were 44 patients who underwent CACS and CTCA. The commonest indication for a CTCA was a positive exercise ECG. Increasing CACS, stenosis severity, and stenosis burden were associated with significantly greater likelihood of occupational restriction (P = occupational restrictions. Two patients with a calcium score ≤10 had at least 1 single vessel stenosis ≥50%. A CTCA pathway is potentially a better discriminator of CAD burden in aircrew when compared with CACS and may reduce downstream testing, allowing a more efficacious approach to CAD assessment in military aircrew.Parsons I, Pavitt C, Chamley R, d'Arcy J, Nicol E. CT coronary angiography vs. coronary artery calcium scoring for the occupational assessment of military aircrew. Aerosp Med Hum Perform. 2017; 88(2):76-81.

  8. Significance of coronary artery calcification detected incidentally with chest CT

    International Nuclear Information System (INIS)

    Moore, E.H.; Greenberg, R.; Miller, S.W.; Shepard, J.O.; Bourgouin, P.M.; McLoud, T.C.

    1987-01-01

    Coronary artery calcifications are well seen on CT scans because of high contrast resolution. Individual vessels were scored 0-3+ based on degree of calcification in over 40 patients who also underwent cardiac catheterization. Though relatively insensitive, the presence of dense calcifications had a specificity of roughly 60% to 70% for the presence of severe stenosis. In addition, 30 patients with calcification on CT scans and 30 age-matched controls, all of whom underwent thoracotomy, were compared with respect to prior cardiac history, estimated anesthetic risk, and postoperative cardiac complications. Patients with calcifications were more likely to have evidence of coronary disease and/or encounter postoperative cardiac complications

  9. Noninvasive imaging of coronary arteries: current and future role of multidetector row computer tomography

    International Nuclear Information System (INIS)

    Nedevska, M.; Stoinova, V.

    2006-01-01

    Full text: This review will present the current and future role of cardiac computer tomography (CCT), and particular multidetector CCT, for imaging of atherosclerotic pathologic changes of the coronary arteries. Atherosclerosis and its cardio-vascular complications represent one of the major issues of public health in industrial countries. Different imaging modalities, including invasive coronarography, have been aimed to the diagnosis of the disease, when it provokes symptomatic decrease of the blood flow. In spite of development of surgical and percutaneous methods for coronary revascularization, coronary artery disease remains the major cause of death in North America and Europe. This demonstrates the need of novel, complementary diagnostic strategies, aimed to identify asymptomatic stages as the basis of pharmacological interventions. Noninvasive coronary angiography with multidetector CT allows both assessment of luminal stenosis and subclinical disease of arterial wall. Large trails are missing now to understand and present what will be the role of this technology in the comprehensive assessment of patients, suspected of having CAD. Based on experience and current potentials we will describe how tomographic coronary imaging may eventually supplement traditional angiographic techniques in understanding the patterns of atherosclerotic CAD development

  10. An Outflow Boundary Condition Model for Noninvasive Prediction of Fractional Flow Reserve in Diseased Coronary Arteries.

    Science.gov (United States)

    Fayssal, Iyad A; Moukalled, Fadl; Alam, Samir; Isma'eel, Hussain

    2018-04-01

    This paper reports on a new boundary condition formulation to model the total coronary myocardial flow and resistance characteristics of the myocardial vascular bed for any specific patient when considered for noninvasive diagnosis of ischemia. The developed boundary condition model gives an implicit representation of the downstream truncated coronary bed. Further, it is based on incorporating patient-specific physiological parameters that can be noninvasively extracted to account for blood flow demand to the myocardium at rest and hyperemic conditions. The model is coupled to a steady three-dimensional (3D) collocated pressure-based finite volume flow solver and used to characterize the "functional significance" of a patient diseased coronary artery segment without the need for predicting the hemodynamics of the entire arterial system. Predictions generated with this boundary condition provide a deep understanding of the inherent challenges behind noninvasive image-based diagnostic techniques when applied to human diseased coronary arteries. The overall numerical method and formulated boundary condition model are validated via two computational-based procedures and benchmarked with available measured data. The newly developed boundary condition is used via a designed computational methodology to (a) confirm the need for incorporating patient-specific physiological parameters when modeling the downstream coronary resistance, (b) explain the discrepancies presented in the literature between measured and computed fractional flow reserve (FFRCT), and (c) discuss the current limitations and future challenges in shifting to noninvasive assessment of ischemia.

  11. Coronary artery bypass surgery in the diabetic patient.

    LENUS (Irish Health Repository)

    Maher, M

    2012-02-03

    Coronary artery and peripheral occlusive arterial disease frequently complicate diabetes mellitus, with death due to atherosclerotic coronary artery disease being three times more likely in diabetic compared to non-diabetic patients. The profile of 32 diabetic patients and 32 matched controls who underwent coronary artery bypass (CABG) is studied and their early and late postoperative outcomes are described. The mean age was 61 +\\/- 1 year in both groups. The diabetic group comprised 26 non-insulin dependent and 6 insulin dependent diabetics, who had a mean duration of diabetes of 8.5 years (range 2 months--35 years). The median number of grafts per patient performed in the diabetic group and the control group was 3.5 and 3 respectively. There was no mortality in the series, however considerably greater wound morbidity rates were encountered in the diabetic group when compared to matched controls. One renal transplant patient in the diabetic group suffered irreversible acute tubular necrosis and became dialysis dependent post-operatively. Longterm follow-up showed no longterm mortality in either group, with full relief of angina achieved in 75% of diabetic patients compared with 87.5% of matched controls. In addition diabetic patients suffered greater longterm cardiac morbidity than the control group (21.8% versus 12.5%). The results of this study suggest that CABG is a safe operation for the diabetic patient. Diabetic patients receive satisfactory symptomatic relief of angina, but suffer increased perioperative wound complications and greater incidence of longterm cardiac morbidity.

  12. Detection of coronary calcium with electron beam tomography in coronary artery disease

    International Nuclear Information System (INIS)

    Haberl, R.; Knez, A.; Becker, A.; Becker, C.; Bruening, R.; Reiser, M.; Maass, A.; Steinbeck, G.

    1998-01-01

    Purpose: Coronary calcium is a powerful indicator of arteriosclerosis and can be detected very precisely with electron beam tomography. The method can be applied in patients with known coronary artery disease or in asymptomatic patients at risk of arteriosclerotic disease. Results: At the University of Munich we performed an EBT scan of the heart in 1100 patients within the last year. In 567 patients coronary angiography was performed also (±3 days). Confirming previous reports in the literature, we found a correlation of the calcium score with the age and gender of the patients. Severe coronary artery disease (stenoses ≥ 75%) was associated with significantly more calcium than less severe CAD. The calcium score did not discriminate between one-, two- and three-vessel disease. The site of calcification does not correlate with the localization of stenoses. Thirty-three percent of the patients with significant coronary artery disease showed a normal age-adjusted calcium score; a total of 8.1% of patients with severe stenoses did not reveal any coronary calcification (score =0). With asymptomatic patients there are only a few studies available. Soft plaques cannot be detected with EBT, but in most patients soft plaques occur together with hard plaques. Our results show that spiral CT of the newest generation may also be used for calcium screening. There was an excellent correlation of the calcium scores of EBT and spiral CT at all levels of calcification. Discussion: Coronary calcium is a sensitive marker of coronary artery disease. In the clinical setting EBT is indicated in patients with known coronary artery disease (to evaluate prognosis), in patients who are unable to perform a stress test, and in patients with atypical chest pain. However, lack of calcification may be associated with severe stenoses in a minority of patients. The clinical value in asymptomatic patients needs to be defined: Randomized studies are necessary. We see a possible indication in

  13. Clinical perspective of coronary computed tomographic angiography in diagnosis of coronary artery disease

    International Nuclear Information System (INIS)

    Chang, Hyuk-Jae; Chung, Namsik

    2011-01-01

    Since a 4-detector row coronary computed tomographic angiography (CCTA) was launched in 1998, CCTA has experienced rapid improvement of imaging qualities with the ongoing evolution of computed tomography (CT) technology. The diagnostic accuracy of CCTA to detect coronary artery stenosis is well established, whereas improvements are still needed to reduce the overestimation of coronary artery disease (CAD) and assess plaque composition. CCTA has been used to evaluate CAD in various clinical settings. For example, CCTA could be an efficient initial triage tool at emergency departments for patients with acute chest pain with low-to-intermediate risk because of its high negative predictive value. In patients with suspected CAD, CCTA could be a cost-effective alternative to myocardial perfusion imaging and exercise electrocardiogram for the initial coronary evaluation of patients with intermediate pre-test likelihood suspected CAD. However, in asymptomatic populations, there is a lack of studies that show an improved prognostic power of CCTA over other modalities. Therefore, the clinical use of CCTA to detect CAD for purposes of risk stratification in asymptomatic individuals should be discouraged. As CT technology evolves, CCTA will provide better quality coronary imaging and non-coronary information with lower radiation exposure. Future studies should cover these ongoing technical improvements and evaluate the prognostic power of CCTA in various clinical settings of CAD in large, well-designed, randomized trials. (author)

  14. Prognosis of non-significant coronary atherosclerotic disease detected by coronary artery tomography

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Marcio Vinicius Lins; Siqueira, Bruna Pinto; Guimaraes, Carolina Camargos Braichi; Cruz, David Filipe Silva; Guimaraes, Leiziane Assuncao Alves; Lima, Maicom Marcio Perigolo, E-mail: marciovlbarros@gmail.com [Faculdade de Saude e Ecologia Humana, Vespasiano, MG (Brazil); Nunes, Maria do Carmo Pereira [Universidade de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Siqueira, Maria Helena Albernaz [Hospital Materdei, Belo Horizonte, MG (Brazil)

    2015-07-15

    Introduction: Although studies have shown high diagnostic accuracy of coronary tomography (CT) in detecting coronary artery disease (CAD), data on the prognostic value of this method in patients with no significant coronary obstruction are limited. Objective: To evaluate the value of CT in predicting adverse events in patients with suspected CAD and no significant coronary obstruction. Methods: We prospectively evaluated 440 patients between January 2008 and July 2013 by MDCT, diagnosed with no significant obstruction or no atherosclerotic coronary obstruction with an average follow-up of 33 months. The outcomes evaluated were: cardiac death, myocardial infarction, unstable angina associated with hospitalization or coronary artery bypass grafting. Results: Of the 440 patients studied, 295 (67%) were men with mean age 55.9 ± 12.0 years. Non-significant obstruction was found in 152 (35%) of the patients and there were 49 (11%) outcomes. In the multivariate analysis using the Cox regression model, the predictors of clinical outcomes were non-significant obstruction on CT (hazard ratio 3.51; 95% CI 1.73 - 7.8; p <0.01), age and hypertension. Non-significant obstruction on CT was associated with adverse clinical outcomes and survival analysis showed a significant difference (log-rank 24.6; p <0.01) in predicting these outcomes. Conclusion: The detection of non-significant atherosclerotic obstruction by CT was associated with the presence of adverse events in patients with suspected CAD, which may prove useful in the risk stratification of these patients. (author)

  15. Treatment strategies in the left main coronary artery disease associated with acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Ahmet Karabulut

    2015-10-01

    Full Text Available Significant left main coronary artery (LMCA stenosis is not rare and reported 3 to 10% of patients undergoing coronary angiography. Unprotected LMCA intervention is a still clinical challenge and surgery is still going to be a traditional management method in many cardiac centers. With a presentation of drug eluting stent (DES, extensive use of IVUS and skilled operators, number of such interventions increased rapidly which lead to change in recommendation in the guidelines regarding LMCA procedures in the stable angina (Class 2a recommendation for ostial and shaft lesion and class 2b recommendation for distal bifurcation lesion. However, there was not clear consensus about the management of unprotected LMCA lesion associated with acute myocardial infarction (MI with a LMCA culprit lesion itself or distinct culprit lesion of other major coronary arteries. Surgery could be preferred as an obligatory management strategy even in the high risk patients. With this review, we aimed to demonstrate treatment strategies of LMCA disease associated with acute coronary syndrome, particularly acute myocardial infarction (MI. In addition, we presented a short case series with LMCA lesion and ST elevated acute MI in which culprit lesion placed either in the left anterior descending artery or circumflex artery. We reviewed the current medical literature and propose simple algorithm for management.

  16. Association of aortic coarctation and malignant right coronary artery anomaly: an unusual cause of angina pectoris

    Science.gov (United States)

    Filho, Rubens Sirtoli; de Almeida, Leonardo Cao Cãmbra; Sirtoli, Maysa Godoy Gomes Mazurek; Pilatti, Liliana Pena; de Carvalho, Marcelo Valladão; Schafranski, Marcelo

    2011-01-01

    A 53-year-old man with exercise-induced ischemia was referred for investigation. Coronary angiography revealed a right coronary artery originating from the trunk of the left coronary artery, and an aortic coarctation was observed on aortography. A CT angiogram confirmed these findings. Resection of the aortic coarctation and reimplantation of the ostial portion of right coronary artery into its native site was performed, and resulted in a satisfactory outcome. The association of an anomalous right coronary artery with aortic coarctation has rarely been described and represents a critical situation where early diagnosis and prompt intervention are essential. PMID:23754906

  17. THE RISK OF CORONARY ARTERY DISEASE DEVELOPMENT IN PATIENTS WITH ANKYLOSING SPONDYLITIS (BECHTEREW’S DISEASE AND PSORIATIC ARTHRITIS: A 10-YEAR PROSPECTIVE FOLLOW-UP STUDY

    Directory of Open Access Journals (Sweden)

    I. Z. Gaidukova

    2016-01-01

    Full Text Available Objective: assessment of coronary artery disease (CAD incidence among patients with ankylosing spondylitis (AS and psoriatic arthritis (PsA without manifestation of cardiovascular diseases.Materials and methods. We analyzed the data of 10-year prospective follow-up of the patient with AS (n = 278, psoriatic arthritis (n = 85 and healthy controls (n = 150 without any cardiovascular diseases. All groups were comparable in regard to cardiovascular risk factors. During these 10 years all new cases of CAD (verified by cardiologist in the study population were tracked.Results. New cases of CAD were fixed in 64 out of 278 patietns with AS and in 16 out of 150 controls (p = 0.0017. Using log-rank MantelCox test and logrank test for trend we demonstrated statistically significant differences in CAD incidence between patients without spondyloarthritis (SpA and patients with AS and PsA (p < 0,0001. The risk of CAD development was higher in PsA group than in the control group; relative risk was 4.16 (95 % confidence interval (CI 2.36–7.33, RR 6.1 (95 % CI 3.05–12.44 (p < 0.05. Increased risk of myocardial infarction was observed both in patients with AS (RR 4.98; 95 % CI 1.54–6.12 and patients with PsA (RR 5.2; 95 % CI 2.4–7.8 comparing to healthy controls. There was no significant difference between the AS-group and the control group in terms of risk of stenocardia development (p > 0.05.Conclusion. The risk of exertional stenocardia in patients with AS was not higher than that in individuals without SpA. However, patients with AS have higher risk of myocardial infarction than those without SpA. PsA patients have increased risk of CAD development comparing to healthy controls and individuals with AS.

  18. Estimation of the flow resistances exerted in coronary arteries using a vessel length-based method.

    Science.gov (United States)

    Lee, Kyung Eun; Kwon, Soon-Sung; Ji, Yoon Cheol; Shin, Eun-Seok; Choi, Jin-Ho; Kim, Sung Joon; Shim, Eun Bo

    2016-08-01

    Flow resistances exerted in the coronary arteries are the key parameters for the image-based computer simulation of coronary hemodynamics. The resistances depend on the anatomical characteristics of the coronary system. A simple and reliable estimation of the resistances is a compulsory procedure to compute the fractional flow reserve (FFR) of stenosed coronary arteries, an important clinical index of coronary artery disease. The cardiac muscle volume reconstructed from computed tomography (CT) images has been used to assess the resistance of the feeding coronary artery (muscle volume-based method). In this study, we estimate the flow resistances exerted in coronary arteries by using a novel method. Based on a physiological observation that longer coronary arteries have more daughter branches feeding a larger mass of cardiac muscle, the method measures the vessel lengths from coronary angiogram or CT images (vessel length-based method) and predicts the coronary flow resistances. The underlying equations are derived from the physiological relation among flow rate, resistance, and vessel length. To validate the present estimation method, we calculate the coronary flow division over coronary major arteries for 50 patients using the vessel length-based method as well as the muscle volume-based one. These results are compared with the direct measurements in a clinical study. Further proving the usefulness of the present method, we compute the coronary FFR from the images of optical coherence tomography.

  19. Stenting of Anomalous Left Main Coronary Artery Stenosis in an Adult with a Retroaortic Course

    Directory of Open Access Journals (Sweden)

    Lanjewar Charan

    2011-01-01

    Full Text Available Coronary bypass graft has been the conventional treatment of choice in anomalous left man coronary artery stenosis. We are reporting an interesting case with anomalous left main coronary artery originating from right aortic sinus having retroaortic course complicated by significant atherosclerotic narrowing of the vessel and its percutaneous management.

  20. Elevated oxidative stress among coronary artery disease patients on statin therapy: A cross sectional study

    Directory of Open Access Journals (Sweden)

    Sabitha Palazhy

    2015-05-01

    Conclusions: Though coronary artery disease subjects had healthy lipid profile, oxidative stress, a recognized risk factor for coronary events, was still elevated among this patient group. Novel risk factors were not found to be major predictors for coronary artery disease among the study subjects.

  1. Congenital Absence of Left Circumflex Artery Detected by Computed Tomography Coronary Angiography: A Case Report

    Directory of Open Access Journals (Sweden)

    Keerati Hongsakul

    2012-01-01

    Full Text Available The congenital absence of the left circumflex artery (LCx is a very rare congenital anomaly of coronary arteries, but it is benign. Currently, the best modality for the diagnosis of coronary anomalies is computed tomography coronary angiography (CTCA. We report a case of congenitally absent LCx with an atypical chest pain.

  2. Exercise thallium-201 myocardial imaging in left main coronary artery disease: sensitive but not specific

    International Nuclear Information System (INIS)

    Rehn, T.; Griffith, L.S.; Achuff, S.C.; Bailey, I.K.; Bulkley, B.H.; Burow, R.; Pitt, B.; Becker, L.C.

    1981-01-01

    To determine the usefulness of thallium-201 scintigraphy for identifying left main coronary artery disease, the results of scintigraphy at rest and during exercise were compared in 24 patients with 50 percent or greater narrowing of the left main coronary artery and 80 patients with 50 percent or greater narrowing of one or more of the major coronary arteries but without left main coronary involvement. By segmental analysis of the scintigrams, perfusion defects were assigned to the left anterior descending, left circumflex or right coronary artery, singly or in combination, and the pattern of simultaneous left anterior descending and circumflex arterial defects was used to identify left main coronary artery disease. Of the 24 patients with left main coronary artery disease, 22 (92 percent) had abnormal exercise scintigrams. Despite this high sensitivity, the pattern of perfusion defects was not specific; the ''left main pattern'' was found in 3 patients (13 percent) with left main coronary artery disease but also in 3 (33 percent) of 9 patients with combined left anterior descending and left circumflex arterial disease, 4 (19 percent) of 21 patients with three vessel disease and 3 (6 percent) of 50 patients with one or two vessel disease but excluding the group with left anterior descending plus left circumflex arterial disease. The pattern of perfusion defects in the patients with left main coronary artery disease was determined by the location and severity of narrowings in the coronary arteries downstream from the left main arterial lesion. Concomitant lesions in other arteries were found in all patients with left main coronary disease (one vessel in 1 patient, two vessels in 7 patients and three vessels in 16). For this reason, it is unlikely that even with improvements in radiopharmaceutical agents and imaging techniques, myocardial perfusion scintigraphy will be sufficiently specific for definitive identification of left main coronary artery disease

  3. Isolated Unilateral Absent Branch Pulmonary Artery with Peripheral Pulmonary Stenosis and Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Sunil Abhishek B

    2017-09-01

    Full Text Available Isolated Unilateral Absent Pulmonary Artery (UAPA is a rare congenital anomaly. It is usually associated with congenital heart defects. A 45 year old male patient presented with complaints of fever with cough and expectoration for 15 days and retrosternal chest discomfort for the previous 2 days. ECG showed diffuse ST segment depression with T wave inversion in the inferior and lateral leads. Coronary Angiogram done through the right femoral approach revealed diffusely diseased Left Anterior Descending (LAD artery that was totally cut off at the mid segment. The Left Circumflex (LCx artery was providing blood supply to the right middle and lower lung areas. There was another collateral arising from the Left Subclavian Artery supplying the right middle and lower lung areas. The left pulmonary artery was normal, but branches supplying the middle and lower lobes of the right lung were absent and the upper lobe branch had pulmonary stenosis. UAPA is a rare clinical entity; collaterals from coronaries are extremely rare in this condition and till now there has not been any case report of unilateral absent branch pulmonary artery with peripheral stenosis of other branches, on the affected side and associated coronary artery disease.

  4. Prognostic Value of Coronary Computed Tomography Imaging in Patients at High Risk Without Symptoms of Coronary Artery Disease.

    Science.gov (United States)

    Dedic, Admir; Ten Kate, Gert-Jan R; Roos, Cornelis J; Neefjes, Lisan A; de Graaf, Michiel A; Spronk, Angela; Delgado, Victoria; van Lennep, Jeanine E Roeters; Moelker, Adriaan; Ouhlous, Mohamed; Scholte, Arthur J H A; Boersma, Eric; Sijbrands, Eric J G; Nieman, Koen; Bax, Jeroen J; de Feijter, Pim J

    2016-03-01

    At present, traditional risk factors are used to guide cardiovascular management of asymptomatic subjects. Intensified surveillance may be warranted in those identified as high risk of developing cardiovascular disease (CVD). This study aims to determine the prognostic value of coronary computed tomography (CT) angiography (CCTA) next to the coronary artery calcium score (CACS) in patients at high CVD risk without symptoms suspect for coronary artery disease (CAD). A total of 665 patients at high risk (mean age 56 ± 9 years, 417 men), having at least one important CVD risk factor (diabetes mellitus, familial hypercholesterolemia, peripheral artery disease, or severe hypertension) or a calculated European systematic coronary risk evaluation of >10% were included from outpatient clinics at 2 academic centers. Follow-up was performed for the occurrence of adverse events including all-cause mortality, nonfatal myocardial infarction, unstable angina, or coronary revascularization. During a median follow-up of 3.0 (interquartile range 1.3 to 4.1) years, adverse events occurred in 40 subjects (6.0%). By multivariate analysis, adjusted for age, gender, and CACS, obstructive CAD on CCTA (≥50% luminal stenosis) was a significant predictor of adverse events (hazard ratio 5.9 [CI 1.3 to 26.1]). Addition of CCTA to age, gender, plus CACS, increased the C statistic from 0.81 to 0.84 and resulted in a total net reclassification index of 0.19 (p value and risk reclassification benefit beyond CACS in patients without CAD symptoms but with high risk of developing CVD. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Regional blood flow analysis and its relationship with arterial branch lengths and lumen volume in the coronary arterial tree

    International Nuclear Information System (INIS)

    Molloi, Sabee; Wong, Jerry T

    2007-01-01

    The limitations of visually assessing coronary artery disease are well known. These limitations are particularly important in intermediate coronary lesions (30-70% diameter stenosis) where it is difficult to determine whether a particular lesion is the cause of ischaemia. Therefore, a functional measure of stenosis severity is needed. The purpose of this study is to determine whether the expected maximum coronary blood flow in an arterial tree is predictable from its sum of arterial branch lengths or lumen volume. Using a computer model of a porcine coronary artery tree, an analysis of blood flow distribution was conducted through a network of millions of vessels that included the entire coronary artery tree down to the first capillary branch. The flow simulation results show that there is a linear relationship between coronary blood flow and the sum of its arterial branch lengths. This relationship holds over the entire arterial tree. The flow simulation results also indicate that there is a 3/4 er relation between coronary blood flow (Q) and the sum of its arterial lumen volume (V). Moreover, there is a linear relationship between normalized Q and normalized V raised to a power of 3/4 over the entire arterial tree. These results indicate that measured arterial branch lengths or lumen volumes can be used to predict the expected maximum blood flow in an arterial tree. This theoretical maximum blood flow, in conjunction with an angiographically measured blood flow, can potentially be used to calculate fractional flow reserve based entirely on angiographic data

  6. Functional assessment of sequential coronary artery fistula and coronary artery stenosis with fractional flow reserve and stress adenosine myocardial perfusion imaging

    Directory of Open Access Journals (Sweden)

    Kuan Leong Yew

    2015-10-01

    Full Text Available Coronary artery fistula is an abnormal connection between one coronary artery to another coronary artery or cardiac chambers. The coronary artery fistula may cause significant shunting of blood and cause “pseudo-stenosis” or “steal phenomenon”. This will also accentuate pre-existing mild-moderate de novo coronary lesions with resultant greater pressure gradient difference across the lesions. Thus, fractional flow reserve can be a useful tool to guide intervention decision on the coronary artery fistula. There are very few published reports regarding the use of FFR to assess coronary artery fistula. In fact, there is no outcome data regarding the deferment of coronary artery fistula intervention when the FFR is not physiologically significant. This case highlighted the use of FFR to evaluate the functional significance of coronary fistula in the setting of ischemia evaluation and it was proven to be safe to defer intervention with good 3 year clinical outcome. Stress adenosine myocardial perfusion imaging correlated with the FFR result.

  7. Angiographic signs of acute thrombosis of the coronary artery in patients with myocardial infarction

    International Nuclear Information System (INIS)

    Zingerman, L.S.; Belozerov, G.E.; Topchiyan, G.S.; Zvereva, T.V.

    1988-01-01

    The results of a retrospective analysis of coronoragrams of 57 patients with myocardial infarction in whom intracoronary throbolytic therapy in the first 24 h of the desease resulted in the recanalization of the occluded infarction-related coronary artery indicating the presence of an obturating thrombus in its lumen are presented. The authors described signs detected during prior coronarography (before radioendovascular recanalization) in patients with acute coronary occlision due to thrombosis of the coronary artery. The most characteristic ones were a ''severed branch'' symptom in the early arterial phase (86%), the stump of the occluded coronary artery in the form of an ''increased contrast bar'' in the late arterial phase (78.9%), the symptom of ''retention'' of a contrast substance in the stump of the coronary artery in the parenchymatous and venous phases of coronography (64%), low detectability of collateral inflows in the distal bed of the acutely occluded coronary artery

  8. Re-implant of the right coronary artery: a surgical technique for the treatment of ostial lesions

    Directory of Open Access Journals (Sweden)

    Bongiovani Hércules Lisboa

    2002-01-01

    Full Text Available Previously described surgical treatment for ostial coronary artery stenosis relied on either venous or arterial bypasses or ostial patch angioplasty. These surgical procedures are performed with bovine pericardium, saphenous vein or internal thoracic artery. We describe a technique of right coronary artery re-implantation into the aorta. The procedure was performed in four patients with right coronary artery ostial stenosis along with other left coronary artery lesions.

  9. Evaluation by multislice computed tomography of atherosclerotic coronary artery plaques in non-culprit, remote coronary arteries of patients with acute coronary syndrome

    International Nuclear Information System (INIS)

    Kunimasa, Taeko; Sugi, Kaoru; Moroi, Masao; Sato, Yuichi

    2005-01-01

    Patients with acute coronary syndrome (ACS) frequently have vulnerable plaques in the remote coronary arteries, suggesting that ACS is part of the pan-coronary process. In the present study the computed tomography (CT) plaque density in non-culprit atherosclerotic coronary artery lesions was evaluated by multi-slice computed tomography (MSCT) in patients with ACS and non-ACS. MSCT was performed in 21 patients with ACS and 53 patients with non-ACS: 16 of the 21 ACS patients (76%) and 30 of the non-ACS 53 patients (57%) had non-calcified plaques in the non-culprit coronary arteries (p=0.18). CT-low-density plaques (CT density <68 Hounsfield units (HU)) were more frequent in the ACS group (13/16 patients, 81%) than in the non-ACS group (13/30 patients, 43%, p=0.03). In addition, the CT density of the non-culprit lesion was significantly lower in patients with ACS than in those with non-ACS (44.1±22.9 and 77.3±33.7 HU, respectively). Patients with ACS more frequently had CT-low-density plaques in the non-culprit, remote arteries than those with non-ACS, which suggests that ACS treatment should focus not only on stabilizing the culprit lesion but also on systemic stabilization of non-culprit lesions. (author)

  10. Current Roles and Future Applications of Cardiac CT: Risk Stratification of Coronary Artery Disease

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Yeonyee Elizabeth [Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Lim, Tae-Hwan [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736 (Korea, Republic of)

    2014-07-01

    Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.

  11. Coronary artery fistulas: symptoms may not correlate to size. An emblematic case and literature review

    OpenAIRE

    Buccheri, D; Pisano, c; Piraino, D; Cortese, B; Dendramis, G; Chirco, PR; Balistreri, CR; Andolina, G; Argano, V; Ruvolo, G

    2015-01-01

    Fistulous communication of coronary with pulmonary arteries in the adults is a common type of coronary artery fistula (CAF)1—3. In most reported cases, the fistula usually arises from the proximal left and/or right coronary arteries via the anterior conal branches that connect to the anterior wall of the main pulmonary artery. These anteriorly located abnormal communications are usually asymptomatic and are incidentally found during an angiography of the coronary arteries in 0.2—0.3% of the e...

  12. Chest pain in patients with arterial hypertension, angiographically normal coronary arteries and stiff aorta: the aortic pain syndrome.

    Science.gov (United States)

    Stakos, Dimitrios A; Tziakas, Dimitrios N; Chalikias, George; Mitrousi, Konstantina; Tsigalou, Christina; Boudoulas, Harisios

    2013-01-01

    Arterial hypertension is often associated with a stiff aorta as a result of collagen accumulation in the aortic wall and may produce chest pain. In the present study, possible interrelationships between aortic function, collagen turnover and exercise-induced chest pain in patients with arterial hypertension and angiographically normal coronary arteries were investigated. Ninety-seven patients with arterial hypertension, angiographically normal coronary arteries and no evidence of myocardial ischemia on nuclear cardiac imaging during exercise test were studied. Of these, 43 developed chest pain during exercise (chest pain group) while 54 did not (no chest pain group). Carotid femoral pulse-wave velocity (PWVc-f) was used to assess the elastic properties of the aorta. Amino-terminal pro-peptides of pro-collagen type I, (PINP, reflecting collagen synthesis), serum telopeptides of collagen type I (CITP, reflecting collagen degradation), pro-metalloproteinase 1 (ProMMP-1), and tissue inhibitor of metalloproteinase 1 (TIMP-1, related to collagen turnover) were measured in plasma by immunoassay. The chest pain group had higher PWVc-f, higher and /CITP ratio, and lower proMMP-1/ TIMP-1 ratio compared to the no chest pain group. PWVc-f (t=2.53, p=0.02) and PINP (t=2.42, p=0.02) were independently associated with the presence of chest pain in multiple regression analysis. Patients with arterial hypertension, exercise-induced chest pain and angiographically normal coronary arteries, without evidence of exercise-induced myocardial ischemia, had a stiffer aorta compared to those without chest pain. Alterations in collagen type I turnover that favor collagen accumulation in the aortic wall may contribute to aortic stiffening and chest pain in these patients.

  13. Application of a Lifestyle-Based Tool to Estimate Premature Cardiovascular Disease Events in Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

    Science.gov (United States)

    Gooding, Holly C; Ning, Hongyan; Gillman, Matthew W; Shay, Christina; Allen, Norrina; Goff, David C; Lloyd-Jones, Donald; Chiuve, Stephanie

    2017-09-01

    Few tools exist for assessing the risk for early atherosclerotic cardiovascular disease (ASCVD) events in young adults. To assess the performance of the Healthy Heart Score (HHS), a lifestyle-based tool that estimates ASCVD events in older adults, for ASCVD events occurring before 55 years of age. This prospective cohort study included 4893 US adults aged 18 to 30 years from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants underwent measurement of lifestyle factors from March 25, 1985, through June 7, 1986, and were followed up for a median of 27.1 years (interquartile range, 26.9-27.2 years). Data for this study were analyzed from February 24 through December 12, 2016. The HHS includes age, smoking status, body mass index, alcohol intake, exercise, and a diet score composed of self-reported daily intake of cereal fiber, fruits and/or vegetables, nuts, sugar-sweetened beverages, and red and/or processed meats. The HHS in the CARDIA study was calculated using sex-specific equations produced by its derivation cohorts. The ability of the HHS to assess the 25-year risk for ASCVD (death from coronary heart disease, nonfatal myocardial infarction, and fatal or nonfatal ischemic stroke) in the total sample, in race- and sex-specific subgroups, and in those with and without clinical ASCVD risk factors at baseline. Model discrimination was assessed with the Harrell C statistic; model calibration, with Greenwood-Nam-D'Agostino statistics. The study population of 4893 participants included 2205 men (45.1%) and 2688 women (54.9%) with a mean (SD) age at baseline of 24.8 (3.6) years; 2483 (50.7%) were black; and 427 (8.7%) had at least 1 clinical ASCVD risk factor (hypertension, hyperlipidemia, or diabetes types 1 and 2). Among these participants, 64 premature ASCVD events occurred in women and 99 in men. The HHS showed moderate discrimination for ASCVD risk assessment in this diverse population of mostly healthy young adults (C statistic, 0

  14. Racial Differences in Associations of Blood Pressure Components in Young Adulthood With Incident Cardiovascular Disease by Middle Age: Coronary Artery Risk Development in Young Adults (CARDIA) Study.

    Science.gov (United States)

    Yano, Yuichiro; Reis, Jared P; Tedla, Yacob G; Goff, David C; Jacobs, David R; Sidney, Stephen; Ning, Hongyan; Liu, Kiang; Greenland, Philip; Lloyd-Jones, Donald M

    2017-04-01

    Data are sparse regarding which blood pressure (BP) components in young adulthood optimally determine cardiovascular disease (CVD) by middle age. To assess which BP components best determine incident CVD events in young adults and determine whether these associations vary by race and age at BP measurement. Using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, this study assessed the longitudinal race-stratified associations between BP and cardiovascular outcomes. CARDIA is a community-based cohort that recruited black and white individuals (age range, 18-30 years) from March 26, 1985, through June 7, 1986. CARDIA followed up participants for up to 28 years, and 94% of the surviving cohort completed at least 1 telephone interview or examination from August 2009 through August 2014. Blood pressures measubred at baseline (Y0) and 15 years later (Y15). Composite CVD events, including coronary heart disease, stroke, heart failure, and other vascular diseases. A total of 4880 participants participated in the study (mean [SD] age, 24.9 [3.6] years at Y0 and 25.0 [3.6] years at Y15; 2223 male [45.6%] at Y0 and 1800 [44.2%] at Y15; 2657 female [54.4%] at Y0 and 2277 [55.8%] at Y0; 2473 black individuals [50.7%] at Y0 and 1994 [48.9%] at Y15; and 2407 white individuals [49.3%] at Y0 and 2083 [51.1%] at Y15). The mean SBP/DBP was 112/69 mm Hg in blacks and 109/68 mm Hg in whites at Y0 and 117/77 mm Hg in blacks and 110/72 mm Hg in whites at Y15. During a 25-year follow-up from Y0, 210 CVD events occurred (twice as many events in blacks [n = 140] compared with whites), of which 131 (87 in blacks) occurred after Y15. With adjustments for covariates, results from Cox proportional hazards models, including SBP and DBP, jointly suggested that, at Y0, SBP (hazard ratio [HR] per 1-SD increase, 1.32; 95% CI, 1.09-1.61) but not DBP (HR, 1.05; 95% CI, 0.88-1.26) was associated with CVD risk in blacks, whereas DBP (HR, 1.74; 95% CI, 1.21-2.50) but not

  15. ranching pattern of the left anterior descending coronary artery in a ...

    African Journals Online (AJOL)

    Branching pattern of the left anterior descending coronary artery is important in explaining variations in occurrence of coronary atherosclerosis, informing management strategies for coronary heart disease and interventional cardiology. Data on African populations are, however, scarce. Since coronary heart disease is ...

  16. Asymptomatic coronary artery disease in Type-2 diabetes

    International Nuclear Information System (INIS)

    Ahmed, S.S.F.; Othman, S.; Meo, S.A.

    2009-01-01

    Objective: To select a subgroup of type-2 diabetics with two additional pre specified risk factors to see that whether there is any benefit of screening such patients. Methodology: Five hundred twenty six patients were sent for treadmill stress test or thallium scan. Those who had abnormal results were advised coronary angiography. The angiographically proven CAD was correlated with various risk factors to find the relationship between the disease and variables. Results: Two hundred thirty five (48%) patients had abnormal results and among them 158 (67%)underwent coronary angiography. Among these 21% had evidence of CAD. Coronary artery bypass grafting (CABG) was performed in 35(33%) patients, catheter based intervention (PCI) in 44(40%) patients and 30(27%) patients were not suitable for intervention. Duration of diabetes, smoking, diabetic retinopathy, albuminuria, and peripheral vascular disease were significant predictor of asymptomatic CAD. Conclusion: This study has demonstrated strong relationship between risk factors and asymptomatic CAD in type 2 diabetics. (author)

  17. Gene therapy and angiogenesis in patients with coronary artery disease

    DEFF Research Database (Denmark)

    Kastrup, Jens

    2010-01-01

    -blind placebo-controlled trials could not confirm the initial high efficacy of either the growth factor protein or the gene therapy approaches observed in earlier small trials. The clinical studies so far have all been without any gene-related serious adverse events. Future trials will focus on whether...... an improvement in clinical results can be obtained with a cocktail of growth factors or by a combination of gene and stem cell therapy in patients with severe coronary artery disease, which cannot be treated effectively with current treatment strategies....... of VEGF and FGF in patients with coronary artery disease. The initial small and unblinded studies with either recombinant growth factor proteins or genes encoding growth factors were encouraging, demonstrating both clinical improvement and evidence of angiogenesis. However, subsequent larger double...

  18. Serum adiponectin levels in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Fayyaz, I.; Shah, S.I.; Ghani, M.

    2009-01-01

    Adiponectin is an adipocytokine secreted from white adipose tissue. Serum level of adiponectin has been shown to be reduced in several disease states like obesity and diabetes. Hypoadiponectinemia has also been included in the list of newer risk factors for Coronary Artery Disease (CAD). In this analytical cross-sectional study serum adiponectin level was measured by Enzyme Linked Immunosorbant Assay (ELISA) in 60 cases of coronary artery disease (CAD) (both sexes, aged 40-60 yrs) and 60 healthy controls. Low levels of adiponectin were seen in CAD patients as well as controls. These levels were lower as compared to western standards. Our study conforms to the previous observation of lower serum adiponectin levels in South Asians compared to the western standards. Serum adiponectin level should be considered in the laboratory work-up of CAD patients. (author)

  19. Depression and coronary artery disease -real heart attack

    International Nuclear Information System (INIS)

    Farooqi, S.; Ahmed, B.

    2001-01-01

    Both depression and ischaemic heart disease are said to become the leading causes of morbidity and mortality in developing countries during the next two decades. The relationship between these two disorders has long been speculated but only recently addressed scientifically. A Medline search was conducted to obtain the articles that address the association between depressive disorders and coronary artery disease (CAD). Most studies following large cohorts over a period ranging from 4.5 to 27 years have shown that depression is associated with a significantly high risk of developing CAD. These studies also show that patients who have depression following myocardial infarction hat poorer prognosis on major cardiac end points like reoccurrence of myocardial infarction and death as compared to the non-depressed group. The psychosocial variables associated with depression like social isolation, acute and chronic stressful life events are also associated with increased risk of developing CAD. The mechanisms underlying this association between depression and CAD are unknown at present. The effectiveness of psychosocial interventions in reducing this increased risks have been demonstrated while the trials assessing the efficacy and safety of anti depressed drugs are underway. The implications of these finding are discussed in the context of developing countries. (author)

  20. Recent perspective on coronary artery bifurcation interventions.

    Science.gov (United States)

    Dash, Debabrata

    2014-01-01

    Coronary bifurcation lesions are frequent in routine practice, accounting for 15-20% of all lesions undergoing percutaneous coronary intervention (PCI). PCI of this subset of lesions is technically challenging and historically has been associated with lower procedural success rates and worse clinical outcomes compared with non-bifurcation lesions. The introduction of drug-eluting stents has dramatically improved the outcomes. The provisional technique of implanting one stent in the main branch remains the default approach in most bifurcation lesions. Selection of the most effective technique for an individual bifurcation is important. The use of two-stent techniques as an intention to treat is an acceptable approach in some bifurcation lesions. However, a large amount of metal is generally left unapposed in the lumen with complex two-stent techniques, which is particularly concerning for the risk of stent thrombosis. New technology and dedicated bifurcation stents may overcome some of the limitations of two-stent techniques and revolutionise the management of bifurcation PCI in the future.

  1. Association Between Lifetime Marijuana Use and Cognitive Function in Middle Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

    Science.gov (United States)

    Auer, Reto; Vittinghoff, Eric; Yaffe, Kristine; Künzi, Arnaud; Kertesz, Stefan G; Levine, Deborah A; Albanese, Emiliano; Whitmer, Rachel A; Jacobs, David R; Sidney, Stephen; Glymour, M Maria; Pletcher, Mark J

    2016-03-01

    Marijuana use is increasingly common in the United States. It is unclear whether it has long-term effects on memory and other domains of cognitive function. To study the association between cumulative lifetime exposure to marijuana use and cognitive performance in middle age. We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of 5115 black and white men and women aged 18 to 30 years at baseline from March 25, 1985, to June 7, 1986 (year 0), and followed up over 25 years from June 7, 1986, to August 31, 2011, to estimate cumulative years of exposure to marijuana (1 year = 365 days of marijuana use) using repeated measures and to assess associations with cognitive function at year 25. Linear regression was used to adjust for demographic factors, cardiovascular risk factors, tobacco smoking, use of alcohol and illicit drugs, physical activity, depression, and results of the mirror star tracing test (a measure of cognitive function) at year 2. Data analysis was conducted from June 7, 1986, to August 31, 2011. Three domains of cognitive function were assessed at year 25 using the Rey Auditory Verbal Learning Test (verbal memory), the Digit Symbol Substitution Test (processing speed), and the Stroop Interference Test (executive function). Among 3385 participants with cognitive function measurements at the year 25 visit, 2852 (84.3%) reported past marijuana use, but only 392 (11.6%) continued to use marijuana into middle age. Current use of marijuana was associated with worse verbal memory and processing speed; cumulative lifetime exposure was associated with worse performance in all 3 domains of cognitive function. After excluding current users and adjusting for potential confounders, cumulative lifetime exposure to marijuana remained significantly associated with worse verbal memory. For each 5 years of past exposure, verbal memory was 0.13 standardized units lower (95% CI, -0.24 to -0.02; P = .02), corresponding to a mean of

  2. [Risk management of coronary artery disease--pharmacological therapy].

    Science.gov (United States)

    Hofmann, Thomas

    2004-06-01

    Treatment of coronary artery disease primarily aims at reducing the severity and frequency of cardiac symptoms and improving prognosis. Both goals can be achieved by the administration of beta-receptor blockers, which are now used as first-line therapy in these patients. Calcium channel blockers or nitrates should be given in the event of contraindications or severe intolerance to beta-receptor blocking therapy. Only long-acting calcium channel blockers should be used in this setting. Another indication for additional treatment with calcium channel blockers and nitrates is given when the efficacy of beta-blocker therapy is not sufficient to relieve symptoms. Nitroglycerin and nitrates are the drugs of choice for the treatment of the acute angina pectoris attack. Calcium channel blockers are used as first-line treatment in patients with vasospastic angina. In patients with syndrome X, nitrates as well as calcium channel blockers or beta-receptor blockers can be administered. In the absence of contraindications, every patient with coronary artery disease should be given aspirin. A daily dosage of 75 to 150 mg is sufficient to reduce the rate of future cardiac events. Clopidogrel should be given in every patient with intolerance or contraindications for aspirin. Increased plasma homocystein levels seem to be a risk factor for coronary artery disease. Homocystein levels can be reduced by dietary means as well as supplementation of folic acid or vitamin B complex. There is no evidence from controlled randomised studies that a decrease of homocystein is beneficial for the prognosis of patients with coronary artery disease.

  3. Constitutive modeling of coronary artery bypass graft with incorporated torsion

    Czech Academy of Sciences Publication Activity Database

    Horný, L.; Chlup, Hynek; Žitný, R.; Adámek, T.

    2009-01-01

    Roč. 49, č. 2 (2009), s. 273-277 ISSN 0543-5846 R&D Projects: GA ČR(CZ) GA106/08/0557 Institutional research plan: CEZ:AV0Z20760514 Keywords : coronary artery bypass graft * constitutive model * digital image correlation Subject RIV: BJ - Thermodynamics Impact factor: 0.439, year: 2009 http://web.tuke.sk/sjf-kamam/mmams2009/contents.pdf

  4. Quantitative analysis of regional myocardial performance in coronary artery disease

    Science.gov (United States)

    Stewart, D. K.; Dodge, H. T.; Frimer, M.

    1975-01-01

    Findings from a group of subjects with significant coronary artery stenosis are given. A group of controls determined by use of a quantitative method for the study of regional myocardial performance based on the frame-by-frame analysis of biplane left ventricular angiograms are presented. Particular emphasis was placed upon the analysis of wall motion in terms of normalized segment dimensions, timing and velocity of contraction. The results were compared with the method of subjective assessment used clinically.

  5. Association of Endodontic Lesions with Coronary Artery Disease

    OpenAIRE

    Liljestrand, J. M.; Mäntylä, P.; Paju, S.; Buhlin, K.; Kopra, K. A. E.; Persson, G. R.; Hernandez, M.; Nieminen, M. S.; Sinisalo, J.; Tjäderhane, L.; Pussinen, P. J.

    2016-01-01

    An endodontic lesion (EL) is a common manifestation of endodontic infection where Porphyromonas endodontalis is frequently encountered. EL may associate with increased risk for coronary artery disease (CAD) via similar pathways as marginal periodontitis. The aim of this cross-sectional study was to delineate the associations between EL and CAD. Subgingival P. endodontalis, its immune response, and serum lipopolysaccharide were examined as potential mediators between these 2 diseases. The Finn...

  6. Local immobilization of the left anterior descending artery for minimally invasive coronary bypass grafting

    NARCIS (Netherlands)

    Boonstra, PW; Grandjean, JG; Mariani, MA

    We describe a device for coronary artery stabilization during minimally invasive coronary artery bypass grafting performed without cardiopulmonary bypass via a small (8 to 10 cm) left anterolateral thoracotomy. This device facilitates the anastomosis of the left internal mammary artery to the left

  7. Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease

    DEFF Research Database (Denmark)

    Mygind, Naja Dam; Michelsen, Marie Mide; Peña, Adam

    2016-01-01

    BACKGROUND: The majority of women with angina-like chest pain have no obstructive coronary artery disease when evaluated with coronary angiography. Coronary microvascular dysfunction is a possible explanation and associated with a poor prognosis. This study evaluated the prevalence of coronary...... microvascular dysfunction and the association with symptoms, cardiovascular risk factors, psychosocial factors, and results from diagnostic stress testing. METHODS AND RESULTS: After screening 3568 women, 963 women with angina-like chest pain and a diagnostic coronary angiogram without significant coronary.......01), hypertension (P=0.02), current smoking (Ppain characteristics or results from diagnostic stress testing...

  8. Coronary arterial Disease associated with arteriosclerosis in lower extremity: Angiographic analysis

    International Nuclear Information System (INIS)

    Kim, Ji Hye; Chung, Jin Wook; Lee, Seon Kyu; Han, Joon Koo; Park, Jae Hyung; Kim, Jae Seung; Han, Man Chung

    1993-01-01

    We performed both peripheral and coronary angiographies in 52 patients with an arteriosclerosis in lower extremities. The severity of arteriosclerotic narrowing of the coronary and peripheral arteries were compared on angiographies. An angiographic vascular score(AVS, 0-5) reflecting the number and the degree of stenosis in 12 lower extremity arteries and three major coronary arteries was assigned to each angiogram and the sun of scores in the lower extremity arteries was compared with the incidence of significant coronary artery disease (more than grade 3) and coronary score. Relation of incidence and severity of vascular stenosis and risk factors (diabetes metallitus, hypertension, smoking, and hypercholesterolemia) was also analyzed. Thirty-four of 52 patients (65%) had an angiographically significant coronary artery disease. Thirteen of these 34 patients (38%) had no clinical symptom and sign of the ischemic heart disease. There was no statistically significant difference in the incidence and severity of coronary artery disease between high (more than 30) and low AVS group in lower extremity (p>0.14). All patients had at least one risk factor and 49 of 52 patients (94%) had multiple risk factors. Coronary angiography was normal in there patients with only one risk factors, and angiographically significant coronary artery disease existed in nine of 16 cases (56.3%) with two risk factors. 13 of 17 case (76.5%) with three risk factors, and 12 of 16 cases (75.0%) with all four risk factors. There were no significant correlations between individual risk factors and incidence, severity of arteriosclerosis in coronary and lower extremity arteries. In conclusion, angiographic evaluation of the coronary artery disease in patients with lower extremity arteriosclerosis is necessary because of the high chance of coronary artery disease and difficulty in the prediction of coronary artery disease with a severity of the peripheral arteriosclerosis, presence of various risk

  9. Coronary artery disease in Brazil: contemporary management and future perspectives.

    Science.gov (United States)

    Polanczyk, C A; Ribeiro, J P

    2009-06-01

    Cardiovascular diseases are responsible for 32% of total mortality in Brazil, mostly due to cerebrovascular and coronary artery disease. Epidemiological and socio-economical factors play a pivotal role on the distribution, severity and management of coronary artery disease, and the burden is greater in the southeast and south regions of the country, with a higher mortality in low-income populations. The Brazilian healthcare structure is divided into two complementary systems-public and private-but 75% of the population is covered exclusively by the public system. Some Brazilian institutions offer state-of-the-art care to patients with acute and chronic coronary artery disease, but regional inequalities in medical care are still significant. National policies will have to be implemented to fight risk factors, to ensure primary prevention strategies, including assistance on drugs with known protective effects, areas to be tackled by both the private and the public health sectors. Finally, large investments will have to be made to improve tertiary care, to reorganise systems of care for acute patients and mainly to ensure prompt access and continuity of cardiac care and secondary prevention strategies for the whole population.

  10. Distribution of ABO Blood Groups and Coronary Artery Calcium.

    Science.gov (United States)

    Wang, Yao; Zhou, Bing-Yang; Zhu, Cheng-Gang; Guo, Yuan-Lin; Wu, Na-Qiong; Qing, Ping; Gao, Ying; Liu, Geng; Dong, Qian; Li, Jian-Jun

    2017-06-01

    ABO blood groups have been confirmed to be associated with cardiovascular diseases such as coronary artery disease. However, whether ABO blood group is correlated with coronary artery calcium (CAC) is still unknown. 301 patients with coronary artery calcium score (CACS) assessed by computed tomography were consecutively enrolled and divided into two groups: with calcium group (CACS>0, n=104) and without calcium group (CACS=0, n=197). Distribution of ABO blood groups was evaluated between the two groups. The percentage of A blood type was significantly higher (p=0.008) and O blood type was significantly lower (p=0.037) in the calcium group. Univariate regression analysis showed that age, total cholesterol, low density lipoprotein cholesterol, high-sensitivity C-reactive protein, A blood type were positively correlated with CAC, and O blood type was inversely associated with CAC. Multivariate regression analysis showed that A blood type was independently associated with CAC (odds ratio: 2.217, 95% confidence interval: 1.260-3.900, p=0.006) even after further adjustment for variables that were clearly different between the two groups. Our data has suggested for the first time that A blood type was an independent risk marker for CAC. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  11. Computational fluid dynamics comparisons of wall shear stress in patient-specific coronary artery bifurcation using coronary angiography and optical coherence tomography

    Science.gov (United States)

    Poon, Eric; Thondapu, Vikas; Chin, Cheng; Scheerlinck, Cedric; Zahtila, Tony; Mamon, Chris; Nguyen, Wilson; Ooi, Andrew; Barlis, Peter

    2016-11-01

    Blood flow dynamics directly influence biology of the arterial wall, and are closely linked with the development of coronary artery disease. Computational fluid dynamics (CFD) solvers may be employed to analyze the hemodynamic environment in patient-specific reconstructions of coronary arteries. Although coronary X-ray angiography (CA) is the most common medical imaging modality for 3D arterial reconstruction, models reconstructed from CA assume a circular or elliptical cross-sectional area. This limitation can be overcome with a reconstruction technique fusing CA with intravascular optical coherence tomography (OCT). OCT scans the interior of an artery using near-infrared light, achieving a 10-micron resolution and providing unprecedented detail of vessel geometry. We compared 3D coronary artery bifurcation models generated using CA alone versus OCT-angiography fusion. The model reconstructed from CA alone is unable to identify the detailed geometrical variations of diseased arteries, and also under-estimates the cross-sectional vessel area compared to OCT-angiography fusion. CFD was performed in both models under pulsatile flow in order to identify and compare regions of low wall shear stress, a hemodynamic parameter directly linked with progression of atherosclerosis. Supported by ARC LP150100233 and VLSCI VR0210.

  12. Refractory angina pectoris in end-stage coronary artery disease : Evolving therapeutic concepts

    NARCIS (Netherlands)

    Schoebel, FC; Frazier, OH; Jessurun, GAJ; DeJongste, MJL; Kadipasaoglu, KA; Jax, TW; Heintzen, MP; Cooley, DA; Strauer, BE; Leschke, M

    1997-01-01

    Refractory angina pectoris in coronary artery disease is defined as the persistence of severe anginal symptoms despite maximal conventional antianginal combination therapy. Further, the option to use an invasive revascularization procedure such as percutaneous coronary balloon angioplasty or

  13. Unipolar Depression and the Progression of Coronary Artery Disease : Toward an Integrative Model

    NARCIS (Netherlands)

    Ormel, Johan; de Jonge, Peter

    2011-01-01

    Background: Despite extensive research on the relationship between depression and coronary artery disease (CAD) after an acute coronary syndrome (ACS), causal interpretations are still difficult. This uncertainty has led to much confusion regarding screening and treatment for depression in CAD

  14. Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents for patients with multivessel coronary artery disease.

    Science.gov (United States)

    Javaid, Aamir; Steinberg, Daniel H; Buch, Ashesh N; Corso, Paul J; Boyce, Steven W; Pinto Slottow, Tina L; Roy, Probal K; Hill, Peter; Okabe, Teruo; Torguson, Rebecca; Smith, Kimberly A; Xue, Zhenyi; Gevorkian, Natalie; Suddath, William O; Kent, Kenneth M; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

    2007-09-11

    Advances in coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) with drug-eluting stents have dramatically improved results of these procedures. The optimal treatment for patients with multivessel coronary artery disease is uncertain given the lack of prospective, randomized data reflecting current practice. This study represents a "real-world" evaluation of current technology in the treatment of multivessel coronary artery disease. A total of 1680 patients undergoing revascularization for multivessel coronary artery disease were identified. Of these, 1080 patients were treated for 2-vessel disease (196 CABG and 884 PCI) and 600 for 3-vessel disease (505 CABG and 95 PCI). One-year mortality, cerebrovascular events, Q-wave myocardial infarction, target vessel failure, and composite major adverse cardiovascular and cerebrovascular events were compared between the CABG and PCI cohorts. Outcomes were adjusted for baseline covariates and reported as hazard ratios. The unadjusted major adverse cardiovascular and cerebrovascular event rate was reduced with CABG for patients with 2-vessel disease (9.7% CABG versus 21.2% PCI; P<0.001) and 3-vessel disease (10.8% CABG versus 28.4% PCI; P<0.001). Adjusted outcomes showed increased major adverse cardiovascular and cerebrovascular event with PCI for patients with 2-vessel (hazard ratio 2.29; 95% CI 1.39 to 3.76; P=0.01) and 3-vessel disease (hazard ratio 2.90; 95% CI 1.76 to 4.78; P<0.001). Adjusted outcomes for the nondiabetic subpopulation demonstrated equivalent major adverse cardiovascular and cerebrovascular event with PCI for 2-vessel (hazard ratio 1.77; 95% CI 0.96 to 3.25; P=0.07) and 3-vessel disease (hazard ratio 1.70; 95% CI 0.77 to 3.61; P=0.19). Compared with PCI with drug-eluting stents, CABG resulted in improved major adverse cardiovascular and cerebrovascular event in patients with 2- and 3-vessel coronary artery disease, primarily in those with underlying diabetes

  15. The effects of fenoldopam on coronary conduit blood flow after coronary artery bypass graft surgery.

    LENUS (Irish Health Repository)

    Halpenny, M

    2012-02-03

    OBJECTIVE: To quantify the effects of fenoldopam, 0.1 microg\\/kg\\/min, on left internal mammary artery (LIMA) and saphenous vein blood flow after coronary anastomosis. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: University teaching hospital, single institution. PARTICIPANTS: Thirty-one American Society of Anesthesiologists III patients undergoing elective coronary revascularization. INTERVENTIONS: A perivascular ultrasonic flow probe (Linton Instrumentation, Norfolk, UK) was placed around the LIMA and saphenous vein graft after coronary anastomosis. MEASUREMENTS AND MAIN RESULTS: Immediately before and at 5-minute intervals for 15 minutes after starting the infusion, blood flow was measured in the LIMA and one saphenous vein graft using a transit time ultrasonic flow probe. Heart rate, blood pressure, and central venous pressure were documented at these time points. Administration of fenoldopam, 0.1 microg\\/kg\\/min, did not alter heart rate or blood pressure. A small, nonsignificant increase in LIMA blood flow occurred during the 15-minute study period (30 +\\/- 12 to 35 +\\/- 10 mL\\/min) in patients who received fenoldopam. No significant changes occurred in the placebo group. CONCLUSIONS: The findings indicate that fenoldopam, 0.1 microg\\/kg\\/min, did not influence coronary conduit blood flow to a clinically significant extent. The small increase in LIMA blood flow may be of greater importance in high-risk patients or in the prevention of coronary arterial spasm.

  16. Spontaneous coronary artery dissection: A retrospective analysis of 19,676 coronary angiograms

    Directory of Open Access Journals (Sweden)

    Dinesha Basavanna

    2017-01-01

    Full Text Available Aim: Spontaneous coronary artery dissection (SCAD is a rare cause of angina, myocardial infarction (MI, and sudden cardiac death (SCD and may frequently manifest as acute coronary syndrome (ACS. The diagnosis of SCAD relies on angiographic visualization of a radiolucent intimal flap. Therapeutic options include medical therapy, percutaneous coronary interventions, and bypass surgery. The aim of this study is to analyze the clinical profile, inhospital outcomes, management, and follow-up of patients with angiographic SCAD. Methods: About 19,676 diagnostic coronary angiograms (CAGs were reviewed retrospectively during a 2-year period; 64 patients had SCAD and were included in the study. Complete medical histories before and during the event as well as treatment regimens were obtained from patients' hospital files. Results: A total of 64 cases of SCAD were considered for the study within an age range of 25–70 years. Fifty-eight patients presented with ACS, two patients presented with unstable angina, one patient presented with rheumatic mitral stenosis in atrial fibrillation, one patient presented with non-ST-elevation myocardial infarction, one patient with dilated cardiomyopathy with left ventricular dysfunction, and one patient with effort. Out of 64 patients, four patients died and the average hospital stay is 3–5 days. Conclusion: SCAD occurs in 0.32% of patients undergoing CAG for evaluation of coronary artery disease. Majority of SCAD occurs in men. The left coronary artery is most commonly affected. The inhospital outcomes are good. Most of the patients with SCAD have good prognosis following optimal medical therapy.

  17. Natural History of Moderate Coronary Artery Stenosis After Surgical Revascularization.

    Science.gov (United States)

    Raza, Sajjad; Blackstone, Eugene H; Houghtaling, Penny L; Olivares, Gabriel; Ravichandren, Kirthi; Koprivanac, Marijan; Bakaeen, Faisal G; Sabik, Joseph F

    2018-03-01

    It remains controversial whether grafting moderately stenosed coronary arteries (MSCAs) influences native-vessel disease progression and whether grafting may protect against late myocardial ischemia. From 1972 to 2011, 55,567 patients underwent primary isolated coronary artery bypass grafting (CABG); 1,902 had a single coronary artery with angiographically moderate (50% to 69%) stenosis and ≥1 postoperative angiogram. Disease progression was studied in 489 nongrafted, 371 internal thoracic artery (ITA)-grafted, and 957 saphenous vein (SV)-grafted MSCAs, as well as patency of 376 ITA and 1,016 SV grafts to these MSCAs. At 1, 5, 10, and 15 years, native-vessel disease progressed from moderate to severe stenosis/occlusion in 32%, 52%, 66%, and 72% of nongrafted MSCAs; 55%, 73%, 84%, and 87% of ITA-grafted MSCAs; and 67%, 82%, 90%, and 92% of SV-grafted MSCAs. After adjusting for patient characteristics, MSCA disease progressed 3.6 times faster with ITA and 10 times faster with SV grafting compared with nongrafting. At these same time points, occlusion of ITA grafts to MSCAs was 8%, 9%, 11%, and 15% and for SV grafts, 13%, 32%, 46%, and 56%; protection from myocardial ischemia by ITA-grafted versus nongrafted MSCAs was 29%, 47%, 59%, and 61%. Most MSCAs progress to severe stenosis or occlusion in the long term. Progression is faster in grafted than nongrafted MSCAs, more so with SV than ITA grafts. However, ITA grafts to such arteries have excellent patency, providing long-term protection from myocardial ischemia. Therefore, ITA grafting of MSCAs should be considered. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Imaging and intervention for coronary artery disease following irradiation of malignant thymoma

    International Nuclear Information System (INIS)

    Fatimi, S.H.

    2012-01-01

    Thymomas are rare malignant epithelial growths, constituting 20% of mediastinal tumours. Resection followed by irradiation may be employed in all thymomas except for stage 1 thymomas. Mediastinal irradiation is associated with coronary artery disease. The mean duration of presentation of post-irradiation coronary artery disease is 16 years (range 3-29 years). In our patient coronary artery disease was found only a year post irradiation. A 55 year old male who presented with complaints of dyspnoea, retrosternal chest pain and heaviness since one year underwent resection for malignant thymoma followed by radiotherapy. He presented with coronary artery disease a year after undergoing mediastinal irradiation. On follow-up, patient was treated successfully by coronary artery bypass graft. This case is an unusual occurrence and suggests that mediastinal irradiation may result in significant coronary artery disease as early as within one year. (author)

  19. Automatic detection of coronary arterial branches from X-ray angiograms

    International Nuclear Information System (INIS)

    Lu, Shan; Eiho, Shigeru

    1992-01-01

    This paper describes a method to trace the coronary arterial boundaries automatically from x-ray angiograms. We developed an automatic procedure to detect the edges of an artery with its branches. The edge point is evaluated by a function based on smoothing differential operator on a searching line which is obtained by using the continuous properties of the arterial edges. Thus the boundary points along the artery are detected automatically. If there exists a branch on the boundary, it can be detected automatically. This information about the branch is stored on the stack of the search information and will be used to detect the branch artery. In our edge detection process, the required user interaction is only the manual definition of a starting point for the search, the direction of the search and the range for search. We tested this method on some images generated by a computer with different stenoses and on a coronary angiogram. These results show that this method is useful for analyzing coronary angiograms. (author)

  20. Acute Myocardial Infarction Due to Spontaneous Dissection of the Right Coronary Artery in a Young Male

    International Nuclear Information System (INIS)

    Papadopoulos, Dimitris P.; Moyssakis, Ioannis; Perakis, Alexandros; Athanasiou, Andreas; Anagnostopoulou, Sophia; Benos, Ioannis; Votteas, Vassilios E.

    2004-01-01

    Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction. We report a case of a 33-year-old male who presented with an acute inferior myocardial infarction. Coronary arteriography performed 3 hours after the episode revealed a dissection involving the middle segment of right coronary artery. Because of a spiral form of dissection and the TIMI 3 flow grade, our patient was treated medically and repeat coronary angiography 6 months later was decided

  1. Fifteen new risk loci for coronary artery disease highlight arterial-wall-specific mechanisms

    DEFF Research Database (Denmark)

    Howson, Joanna M. M.; Zhao, Wei; Barnes, Daniel R

    2017-01-01

    Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Although 58 genomic regions have been associated with CAD thus far, most of the heritability is unexplained, indicating that additional susceptibility loci await identification. An efficient discovery strategy ...

  2. Serum protein profiles predict coronary artery disease in symptomatic patients referred for coronary angiography

    Directory of Open Access Journals (Sweden)

    LaFramboise William A

    2012-12-01

    Full Text Available Abstract Background More than a million diagnostic cardiac catheterizations are performed annually in the US for evaluation of coronary artery anatomy and the presence of atherosclerosis. Nearly half of these patients have no significant coronary lesions or do not require mechanical or surgical revascularization. Consequently, the ability to rule out clinically significant coronary artery disease (CAD using low cost, low risk tests of serum biomarkers in even a small percentage of patients with normal coronary arteries could be highly beneficial. Methods Serum from 359 symptomatic subjects referred for catheterization was interrogated for proteins involved in atherogenesis, atherosclerosis, and plaque vulnerability. Coronary angiography classified 150 patients without flow-limiting CAD who did not require percutaneous intervention (PCI while 209 required coronary revascularization (stents, angioplasty, or coronary artery bypass graft surgery. Continuous variables were compared across the two patient groups for each analyte including calculation of false discovery rate (FDR ≤ 1% and Q value (P value for statistical significance adjusted to ≤ 0.01. Results Significant differences were detected in circulating proteins from patients requiring revascularization including increased apolipoprotein B100 (APO-B100, C-reactive protein (CRP, fibrinogen, vascular cell adhesion molecule 1 (VCAM-1, myeloperoxidase (MPO, resistin, osteopontin, interleukin (IL-1β, IL-6, IL-10 and N-terminal fragment protein precursor brain natriuretic peptide (NT-pBNP and decreased apolipoprotein A1 (APO-A1. Biomarker classification signatures comprising up to 5 analytes were identified using a tunable scoring function trained against 239 samples and validated with 120 additional samples. A total of 14 overlapping signatures classified patients without significant coronary disease (38% to 59% specificity while maintaining 95% sensitivity for patients requiring

  3. Perioperative outcomes in minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with sternotomy.

    Science.gov (United States)

    Tekin, Ali İhsan; Arslan, Ümit

    2017-09-01

    Surgical treatment of isolated left anterior descending coronary artery disease can be performed with either minimally invasive direct coronary artery bypass via a left anterior thoracotomy (MIDCAB) or off-pump coronary artery bypass via a median sternotomy (OPCAB). To compare the perioperative outcomes of patients undergoing MIDCAB or OPCAB surgery. Patients who underwent either MIDCAB or OPCAB for isolated left anterior descending (LAD) coronary artery disease between October 2013 and December 2015 were retrospectively evaluated. Operations were carried out by the same surgical team. Preoperative, intraoperative and postoperative data of the patients were recorded for analyses. Twenty-three patients (7 females, 16 males) underwent MIDCAB surgery, and 24 patients (4 female, 20 males) underwent OPCAB surgery. The two groups were comparable regarding preoperative patient characteristics. Duration of mechanical ventilation (5.1 ±0.7 h vs. 6.6 ±0.9 h), intensive care unit stay (19.4 ±2.5 h vs. 45.8 ±5.4 h) and hospital stay (4.3 ±0.4 days vs. 5.6 ±0.8 days) were significantly shorter in the MIDCAB group (p < 0.01). Patients in the OPCAB group required significantly more blood transfusions (1.83 ±0.38 units vs. 0.17 ±0.38 units) and fresh frozen plasma use (2.33 ±0.96 units vs. 0.69 ±0.76 units) (p < 0.01). Conversion to sternotomy was not required in the MIDCAB group. There was no mortality, conversion to cardiopulmonary bypass or serious complication in either group. We believe that the MIDCAB technique is more advantageous than the OPCAB technique in the treatment of patients with a critical LAD lesion.

  4. Quantitative Measurement of Dissection Resistance in Intimal and Medial Layers of Human Coronary Arteries

    OpenAIRE

    Wang, Ying; Johnson, John A.; Spinale, Francis G.; Sutton, Michael A.; Lessner, Susan M.

    2013-01-01

    The left anterior descending (LAD) coronary artery is the most frequently involved vessel in coronary artery dissection, a cause of acute coronary syndrome or sudden cardiac death. The biomechanical mechanisms underlying arterial dissection are not well understood. This study investigated the dissection properties of LAD specimens harvested from explanted hearts at the time of cardiac transplantation, from patients with primary dilated cardiomyopathy (n=12). Using a previously validated appro...

  5. Linkages between oral commensal bacteria and atherosclerotic plaques in coronary artery disease patients

    OpenAIRE

    Chhibber-Goel, Jyoti; Singhal, Varsha; Bhowmik, Debaleena; Vivek, Rahul; Parakh, Neeraj; Bhargava, Balram; Sharma, Amit

    2016-01-01

    Coronary artery disease is an inflammatory disorder characterized by narrowing of coronary arteries due to atherosclerotic plaque formation. To date, the accumulated epidemiological evidence supports an association between oral bacterial diseases and coronary artery disease, but has failed to prove a causal link between the two. Due to the recent surge in microbial identification and analyses techniques, a number of bacteria have been independently found in atherosclerotic plaque samples from...

  6. Relation of coronary vasoreactivity and coronary calcification in asymptomatic subjects with a family history of premature coronary artery disease

    International Nuclear Information System (INIS)

    Pirich, Christian; Leber, Alexander; Knez, Andreas; Bengel, Frank M.; Nekolla, Stephan G.; Schwaiger, Markus; Haberl, Ralph

    2004-01-01

    Electron-beam computed tomography (EBCT) allows non-invasive imaging of coronary calcification and has been promoted as a screening tool for coronary artery disease (CAD) in asymptomatic high-risk subjects. This study assessed the relation of coronary calcifications to alterations in coronary vascular reactivity by means of positron emission tomography (PET) in asymptomatic subjects with a familial history of premature CAD. Twenty-one subjects (mean age 51±10 years) underwent EBCT imaging for coronary calcifications expressed as the coronary calcium score (CCS according to Agatston) and rest/adenosine-stress nitrogen-13 ammonia PET with quantification of myocardial blood flow (MBF) and coronary flow reserve (CFR). The mean CCS was 237±256 (median 146, range 0-915). The CCS was 100 units in 13. As defined by age-related thresholds, 15 subjects had an increased CCS (>75th percentile). Overall mean resting and stress MBF and CFR were 71±16 ml 100 g -1 min -1 , 218±54 ml 100 g -1 min -1 and 3.20±0.77, respectively. Three subjects with CCS ranging from 114 to 451 units had an abnormal CFR (<2.5). There was no relation between CCS and resting or stress MBF or CFR (r=0.17, 0.18 and 0.10, respectively). In asymptomatic subjects a pathological CCS was five times more prevalent than an abnormal CFR. The absence of any close relationship between CCS and CFR reflects the fact that quantitative myocardial perfusion imaging with PET characterises the dynamic process of vascular reactivity while EBCT is a measure of more stable calcified lesions in the arterial wall whose presence is closely related to age. (orig.)

  7. Usefulness of detecting atherosclerosis by computed tomography. A relation to coronary artery stenosis

    International Nuclear Information System (INIS)

    Takasu, Junichiro; Yamamoto, Rie; Yokoyama, Kenichi

    1999-01-01

    Reports evaluating coronary artery calcification detection by nonenhanced computed tomography (CT) have verified the usefulness for diagnosis of coronary artery disease. In the condition of a mobile CT scanning at a public health examination, however, determination of coronary calcification remains unclear. We investigated, under this scanning condition, a relation between the characteristic of coronary artery calcification determined by conventional CT and coronary disease on arteriogram. The quantification of aortic wall thickening by enhanced CT was examined on the usefulness of detecting coronary artery disease. The CT density score and the characteristics of aortic atherosclerosis for 159 male patients 30 year-old or more (average age 60.7 years) were examined the relation to coronary artery stenoses. The CT density score was the strongest independent variable for determining the existence of coronary disease. The CT density cutoff score for detection of coronary disease was 50 equal to 50 HU the maximal CT density in the coronary arteries. The maximal aortic wall thickness was the strongest significant variable independent of the noted coronary risk factors for the severity of coronary stenosis on arteriogram. (author)

  8. The anomalous origin of coronary arteries causing sudden death and its clinical significance

    International Nuclear Information System (INIS)

    Zhu Jiemin; Fan Lijuan; Sun Fengwei; Wu Xuesheng; Ying Yuanning; Dong Zhi; Li Xu

    2010-01-01

    Objective: To investigate the morbidity of anomalous coronary origin from the opposite coronary sinus, which may cause sudden death of young athletes in Chinese population. And to identify the imaging characteristics of this anomaly and its clinical significance combined with literature review. Methods: The computed tomographic coronary angiography (CTCA) database at TEDA International Cardiovascular Hospital was reviewed. All of the patients diagnosed with isolated anomalous origin of a coronary artery from the opposite sinus of valsalva (anomalous origin of coronary artery, AOCA) and subsequent coursing between the pulmonary artery and the aorta were collected from 14343 Chinese individuals. The location of anomalous coronary origin, the shape and course of the proximal ectopic arterial segments were identified. The nonatherosclerostic stenotic caliber of the segments and the angle between the ectopic coronary artery and the adjacent aortic wall were assessed. Results: Seventy-four patients of AOCA (including the left or right single coronary artery) were diagnosed using CTCA. Among the 74 cases, the potentially serious course of the ectopic coronary artery between the pulmonary artery and the aorta were identified in 59 individuals. Fifty-six cases of ectopic right coronary with interarterial course (anomalous origin of right coronary artery, AORCA) and three patients with anomalous origin of the left coronary artery (AOLCA) were found, including two cases judged as potentially serious origin of either single left coronary artery (n=1) or single right coronary artery (n=1). The morbidity of the potentially serious anomalous origin of coronary artery in Chinese population was established as 4.1% (59/14343). In the subgroup of AORCA, the lumen of initial ectopic segment was frequently compressed and stenotic. In 29 cases (52.7%) the stenosis of the lumen were more than 50%, and in 3 cases (5.4%) the stenosis of the ectopic coronary artery were more than 70%. The

  9. Transesophageal echocardiography in the assessment of coronary arteries; Echokardiografia przezprzelykowa w ocenie proksymalnych odcinkow naczyn wiencowych

    Energy Technology Data Exchange (ETDEWEB)

    Adamek-Kosmider, A.; Kasprzak, J.; Kosmider, M.; Krzeminska-Pakula, M. [Akademia Medyczna, Lodz (Poland)

    1993-12-31

    The study was undertaken to assess the usefulness of TEE for evaluation of morphology and flow in coronary arteries. TEE (2D, spectral and color Doppler imaging) and coronary angiography were performed in 75 patients - 41 with valvular heart disease and 34 with ischemic heart disease. Proximal coronary artery stenosis was detected by coronarography in 11 pts (9-left main coronary artery, 2-right coronary artery). TEE visualization of proximal coronary arteries was possible in all pts. Echocardiographic features of artery stenosis were: the narrowing of the vessel in 2D image (9 pts), high flow velocity spectral Doppler (4 pts, mean 135 cm/s vs 55 cm/s in normal arteries) and mosaic, turbulent flow in color Doppler (10 pts). Sensitivity and specificity of TEE for coronary artery stenosis detection was respectively 81%/98% for 2D imaging and 90%/100% for color Doppler. TEE is a new, noninvasive and safe method for the evaluation of proximal coronary arteries. Detection of LMCA stenosis prior to atheterization may enhance the safety of coronary angiography. (author) 21 refs, 8 figs

  10. Takayasu Arteritis of the Coronary Arteries Presenting as Sudden Death in a White Teenager.

    Science.gov (United States)

    Hlavaty, Leigh; Diaz, Francisco; Sung, LokMan

    2015-09-01

    Takayasu arteritis is a rare disease that expresses chronic, large vessel inflammation. The etiology remains unclear and its presentation depends on the affected arteries. With coronary artery involvement, manifestations range from chest pain and shortness of breath to sudden death. We report a case of a 15-year-old white girl who presented with syncope immediately before passing. On autopsy, all 3 major coronary arteries grossly contained multiple proximal lesions that were consistent with Takayasu arteritis, microscopically. Takayasu arteritis solely affecting multiple coronary arteries is exceedingly rare. This report discusses the significance of coronary involvement in Takayasu arteritis at autopsy and sudden death.

  11. Haptoglobin phenotypes as a risk factor for coronary artery disease ...

    African Journals Online (AJOL)

    Gehan Hamdy

    2014-04-22

    Apr 22, 2014 ... Recognition of diabetic individuals at greatest risk of developing coronary ..... Early detection of the disease and timely interventions can reduce the morbidity ..... additional risk factor of retinopathy in type 2 diabetes mellitus.

  12. Analysis of risk factors in obese patients with coronary artery disease, with and without diabetes mellitus type two

    Directory of Open Access Journals (Sweden)

    Vasić Danjela

    2014-01-01

    Full Text Available Diabetes mellitus type 2 is one of the leading chronic diseases in the world and in our country, which is an important risk factor for development of cardiovascular morbidity and mortality. Objective. The aim of this research was making the estimation of risk factors in the etiology of coronary heart disease in obese patients with diabetes mellitus type 2. The study included 82 obese patients, of which 52 with diabetes mellitus and 30 without diabetes mellitus, in all of them coronary artery disease proven by coronary angiography. All were examined by clinical examination, laboratory tests and echocardiography. Based on the test results we found that the distribution of risk factors such as hypertension, family burden coronary artery disease, smoking, alcohol intake was the same in the obese patients with diabetes mellitus, and of those without diabetes mellitus. Echocardiography showed significantly larger left ventricle, lower ejection fraction, larger left atrium and significant mitral regurgitation. Also, in a group of patients with diabetes mellitus, there was significantly higher number of patients with multiple vessel coronary disease. Despite the small sample, we can conclude that the present of diabetes mellitus in obese patients is crucial for severe forms of coronary artery disease. Severity is expressed through significant structural and functional changes in the left ventricle and the number of diseased coronary arteries.

  13. Life Style Interventions in the Prevention of Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Sridhar Dwivedi

    2015-06-01

    Full Text Available Lifestyle diseases particularly coronary artery disease (CAD has been noted to be the most important   cause of the morbidity and mortality all over the world.  India is currently passing through this epidemic so much  so that it would be taking a heavy toll of Indian youth and economy to the tune of some 1.6 trillion $ during 2015-2030 . The main causative factors for CAD identified as coronary risk factors are: smoking / tobacco, physical inactivity, faulty diet, hypertension, diabetes, high level of cholesterol and stress. As most of these risk factors are lifestyle related attempt to modify them by appropriate interventions form the cornerstone of prevention of CAD epidemic.  Studies done by Dean Ornish and several others prompted us to plan an interventional case control study in 640 patients of established CAD. These cases were given power point presentation regarding healthy lifestyle on one to one basis and followed up at three and six months. Primary outcomes variable were change in smoking /tobacco habits, physical activity, obesity, dietary habits, control of hypertension, diabetes and lipid profile.  At the end of intervention it was possible to bring down the tobacco consumption, improve physical activity, better control of hypertension ( p< 0.03 , reduction in obesity ( p= 0. 0005 and raising HDL cholesterol ( p 0.05 significantly in test group.  Taking cue from above study a five step innovative strategy was developed for effective implementation of healthy life style in coronary patients attending Cardiac Clinic at HAH Centenary Hospital, Jamia Hamdard. This strategy  included sensitizing patients to  locally developed visuals , posters and pamphlets at  registration desk , concurrent counseling by attending doctor  at the end of clinical examination ,  and showing patients  and their  family the features of atherosclerosis during  carotid  ultrasound assessment . These points were again reinforced at follow up

  14. Nuclear cardiology procedures to diagnose ischemia in coronary artery disease

    International Nuclear Information System (INIS)

    Kropp, J.

    1999-01-01

    Nuclear cardiology is equipped with a broad spectrum of diagnostic capabilities which allow the evaluation of ventricular performance, perfusion and metabolism of the heart. The principle of nuclear medicine procedures consists in the administration of free radioisotopes or radiopharmaceuticals to detect their spatial distribution within the body by detecting their y-rays from outside by gamma cameras. Myocardial perfusion scintigraphy is the most important procedure in nuclear cardiology and is performed on a routine basis with 201 Thallium-Chloride ( 201 Tl) since 1975. With the Single-Photon Emission Computerized Tomography (SPECT) technique it is possible to diagnose ischemia of the left ventricle on the basis of coronary artery disease with a sensitivity of 90-95% and a specificity of about 55%. Recently 99m Tc-tracers were developed for this purpose, which have many advantages due to their better physical properties, their easy handling and availability. The diagnostic accuracy is the same compared to ( 201 Tl). Free fatty acids labeled with 123 Iodine like 123 IPPA are alternative tracers to diagnose ischemia by the metabolic alteration and are pathognomonic tracers to diagnose the heart involvement in myopathies or metabolic defects related to fatty acid degradation which are the main fuel of the normal myocytes. Finally we should not forget the radionuclide ventriculography (RNVG) which is one of the oldest nuclear cardiology procedures providing us with very objective, reliable results of ventricular performance. (orig.)

  15. Evaluation of olfactory memory after coronary artery bypass grafting.

    Science.gov (United States)

    Erdem, Kemalettin; Yurttas, Veysel; Bilgi, Murat; Demırhan, Abdullah; Apuhan, Tayfun; Bugra, Onursal; Daglar, Bahadir

    2014-12-01

    This study determined whether coronary artery bypass grafting (CABG) surgery has any effect on olfactory function, employing the Brief Smell Identification Test (B-SIT). All the participants were informed preoperatively about the B-SIT test and the mode of its application. The test was performed by each patient preoperatively (d0) as well as 1 (d1) and 3 (d3) days following the surgery. C-reactive protein (CRP) levels were recorded at the same time as the smell test. This prospective study included 45 patients. The mean age was 67 ± 7.55, and the group was 29% male. The mean durations of cross clamping and cardiopulmonary bypass were 54 ± 32 min and 62.5 ± 37.0 min, respectively. Eleven different odors were tested. Significant differences were observed for several odors: leather between d0 and d3, pine between d0 and d3, onion between d0 and d1, onion between d0 and d3, and soap between d0 and d1. The postoperative CRP levels were significantly higher than the preoperative levels. The correlation analysis determined that the postoperative CRP levels were negatively correlated with the B-SIT score (r = -0.48, p = 0.001). Our findings suggest that patients after CABG are prone to develop olfactory dysfunction in the early postoperative period and that olfactory dysfunction is associated with postoperative CRP levels.

  16. Imaging experimental coronary artery thrombosis with indium-111 platelets

    International Nuclear Information System (INIS)

    Riba, A.L.; Thakur, M.L.; Gottschalk, A.; Zaret, B.L.

    1979-01-01

    The ability of cardiac scintigraphy with indium-111 ( 111 In)-labeled platelets to detect coronary artery thrombosis (CAT) was assessed in a canine model. Cardiac imaging and tissue distribution studies were performed shortly after administering 111 In-labeled platelets to 12 dogs (group 1) with acute CAT. Four dogs (group 2) with acute CAT were studied 2 and 22 hours after administering 111 In platelets. In addition, four dogs (group 3) with 24-hour-old CAT were similarly evaluated. In all group 1 animals, in vivo imaging 1 to 2 hours after 111 In platelet administration revealed intense uptake in the region of thrombus-containing left anterior descending arteries that was readily discernible from background blood pool activity. Sequential imaging of the four group 2 animals over a 22-hour period revealed no change in the scintigraphic pattern of the thrombosed arteries. In contrast, 111 In platelet imaging in the four group 3 animals with 24-hour-old CAT failed to reveal enhanced activity within the region of the thrombus-containing coronary artery. In the 12 group 1 animals, the CAT accumulated 69 +- 10 (mean +- SEM) times greater activity than present in blood and 651 +- 135 times greater activity than normal left ventricular myocardium. There was 24 +- 7 times greater 111 In activity in the damaged left anterior descending arteries compared with normal circumflex arteries. Similar uptake ratios were seen in group 2 animals. The 24-hour old thrombi from group 3 animals showed no enhanced 111 In uptake. This study demonstrates that experimental acute CAT can be detected readily with 111 In platelet cardiac scintigraphy

  17. Glycemic control in type 2 diabetes mellitus prevents coronary arterial wall infection

    Directory of Open Access Journals (Sweden)

    Morteza Izadi

    2014-05-01

    Full Text Available BACKGROUND: Diabetes mellitus (DM is a very well-known risk factor for development of atherosclerosis, and it has been hypothesized that poor glycemic control and hyperglycemia plays a major role in this process. In the current study, we aimed to evaluate the associates of poor glycemic control in Iranian patients who have already undergone coronary artery bypass grafting (CABG, with especial focus on the inhabitation of infectious agents within the coronary arterial wall. METHODS: In January 2010, 52 consecutive patients with type 2 DM who undergone CABG at the Department of Cardiovascular Surgery of Baqiyatallah University of Medical Sciences (Tehran, Iran were included into this cross-sectional study and biopsy specimens from their coronary plaques were taken and analyzed by polymerase chain reaction (PCR methods for detecting Helicobacter species, cytomegalovirus (CMV and Chlamydia pneumoniae, and their potential relation to the glycemic control status in these patients. RESULTS: Compared to that in diabetic patients with mean fasting blood sugar (FBS levels FBS < 126, atherosclerotic lesions in type 2 diabetic patients with poor glycemic control (FBS > 126 were significantly more likely to be positive for CMV PCR test (41% vs. 9%, respectively; P = 0.05. In laboratorial test results, mean triglyceride level was significantly higher among patients of poor glycemic control (168 ± 89 vs. 222 ± 125 mg/dl, respectively; P = 0.033. Hypertension was also significantly more prevalent in this population (73% vs. 36%, respectively; P = 0.034. CONCLUSION: Type 2 diabetic patients with poor glycemic control can be at higher risk for developing CMV infection in their coronary arterial wall, which can promote atherosclerosis formation process in this patient population. According to the findings of this study, we recommend better control of serum glucose levels in type 2 diabetic patients to prevent formation/progression of atherosclerosis.   Keywords

  18. [Comparison of 64 MDCT coronary CTA and coronary angiography in the detection of coronary artery stenosis in low risk patients with stable angina and acute coronary syndrome].

    Science.gov (United States)

    Cazalas, G; Sarran, A; Amabile, N; Chaumoitre, K; Marciano-Chagnaud, S; Jacquier, A; Paganelli, F; Panuel, M

    2009-09-01

    To determine the accuracy of 64 MDCT coronary CTA (CCTA) compared to coronary angiography in low risk patients with stable angina and acute coronary syndrome and determine the number of significant coronary artery stenoses ( 50%) in these patients. Materials and methods. Fifty-five patients underwent CCTA using a 32 MDCT unit with z flying focus allowing the acquisition of 64 slices of 0.6 mm thickness as well as coronary angiography (gold standard). Nine patients were excluded due to prior coronary artery bypass surgery (n=4), insufficient breath hold (n=3), calcium scoring>1000 (n=1) and delay between both examinations over 4 months (n=1). Forty-six patients: 27 males and 19 females were included. CCTA results were compared to coronary angiography per segment and artery with threshold detection of stenoses 50%. The degree of correlation between both examinations was performed using a regression analysis with a Pearson correlation coefficient<0.05 considered significant. The overall accuracy of CCTA was 90%; limitations related to the presence of calcifications, motion artifacts or insufficient vessel opacification. The correlation for all analyzed segments was 96.4%. Thirty-eight of 50 significant stenoses seen on coronary angiography were correctly detected on CCTA. Sensitivity, specificity, PPVC and NPV for detection of stenoses 50% were 76%, 98.3%, 80.3% and 97.7% respectively. Evaluation per segment had a NPV of 96.8% (interventricular and diagonal segments) to 100% (main trunk). Our results for specificity and NPV are similar to reports from the literature. This suggests that CCTA in this clinical setting may replace coronary angiography.

  19. A mechanical argument for the differential performance of coronary artery grafts.

    Science.gov (United States)

    Prim, David A; Zhou, Boran; Hartstone-Rose, Adam; Uline, Mark J; Shazly, Tarek; Eberth, John F

    2016-02-01

    Coronary artery bypass grafting (CABG) acutely disturbs the homeostatic state of the transplanted vessel making retention of graft patency dependent on chronic remodeling processes. The time course and extent to which remodeling restores vessel homeostasis will depend, in part, on the nature and magnitude of the mechanical disturbances induced upon transplantation. In this investigation, biaxial mechanical testing and histology were performed on the porcine left anterior descending artery (LAD) and analogs of common autografts, including the internal thoracic artery (ITA), radial artery (RA), great saphenous vein (GSV) and lateral saphenous vein (LSV). Experimental data were used to quantify the parameters of a structure-based constitutive model enabling prediction of the acute vessel mechanical response pre-transplantation and under coronary loading conditions. A novel metric Ξ was developed to quantify mechanical differences between each graft vessel in situ and the LAD in situ, while a second metric Ω compares the graft vessels in situ to their state under coronary loading. The relative values of these metrics among candidate autograft sources are consistent with vessel-specific variations in CABG clinical success rates with the ITA as the superior and GSV the inferior graft choices based on mechanical performance. This approach can be used to evaluate other candidate tissues for grafting or to aid in the development of synthetic and tissue engineered alternatives. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Detection of coronary artery disease - comparison of exercise stress radionuclide angiocardiography and thallium stress perfusion scanning

    International Nuclear Information System (INIS)

    Jengo, J.A.; Freeman, R.; Brizendine, M.; Mena, I.; St. Mary Medical Center, Long Beach, Calif.)

    1980-01-01

    Exercise thallium scanning and stress radionuclide angiography were compared in 16 normal subjects and 42 patients with more than 75% coronary arterial obstruction in studies using upright exercise on a bicycle ergometer. Studies at rest were subsequently obtained. Exercise thallium scans in the control group were normal in 15 and showed a defect in 1. Ejection fraction increased in all 16. During exercise, regional wall motion increased uniformly. In the group with coronary artery disease, thallium scanning revealed a new defect in the distribution of the involved arteries in 24 patients. In 15 who had a defect at rest, no new defect developed, but in 9 of the 15 new segmental wall motion defects were evident on radionuclide angiography. With exercise, ejection fraction decreased slightly. Regional wall motion abnormalities developed in the areas corresponding to thallium defects in all. Thallium scanning had a 93% and radionuclide angiography a 98% sensitivity value in detecting coronary artery disease. The respective specificity values were 94 and 100%. In patients with prior myocardial infarction who manifested new exercise abnormalities, 50% showed new thallium defects and 81% new wall motion defects

  1. Localization of coronary artery disease with exercise electrocardiography: correlation with thallium-201 myocardial perfusion scanning

    International Nuclear Information System (INIS)

    Dunn, R.F.; Freedman, B.; Bailey, I.K.; Uren, R.F.; Kelly, D.T.

    1981-01-01

    In 61 patients with single vessel coronary artery disease (70 percent or greater obstruction of luminal diameter in only one vessel) and no previous myocardial infarction, the sites of ischemic changes on 12 lead exercise electrocardiography and on thallium-201 myocardial perfusion scanning were related to the obstructed coronary artery. The site of exercise-induced S-T segment depression did not identify which coronary artery was obstructed. In the 37 patients with left anterior descending coronary artery disease S-T depression was most often seen in the inferior leads and leads V4 to V6, and in the 18 patients with right coronary artery disease and in the 6 patients with left circumflex artery disease S-T depression was most often seen in leads V5 and V6. Although S-T segment elevation was uncommon in most leads, it occurred in lead V1 or a VL, or both, in 51 percent of the patients with left anterior descending coronary artery disease. A reversible anterior defect on exercise thallium scanning correlated with left anterior descending coronary artery disease (probability [p] less than 0.0001) and a reversible inferior thallium defect correlated with right coronary or left circumflex artery disease (p less than 0.0001). In patients with single vessel disease, the site of S-T segment depression does not identify the obstructed coronary artery; S-T segment elevation in lead V1 or aVL, or both, identifies left anterior descending coronary artery disease; and the site of reversible perfusion defect on thallium scanning identifies the site of myocardial ischemia and the obstructed coronary artery

  2. Distribution of coronary arterial capacitance in a canine model.

    Science.gov (United States)

    Lader, A S; Smith, R S; Phillips, G C; McNamee, J E; Abel, F L

    1998-03-01

    The capacitative properties of the major left coronary arteries, left main (LM), left anterior descending (LAD), and left circumflex (LCX), were studied in 19 open-chest isolated dog hearts. Capacitance was determined by using ramp perfusion and a left ventricular-to-coronary shunt diastolic decay method; both methods gave similar results, indicating a minimal systolic capacitative component. Increased pericardial pressure (PCP), 25 mmHg, was used to experimentally alter transmural wall pressure. The response to increased PCP was different in the LAD vs. LCX; increasing PCP decreased capacitance in the LCX but increased capacitance in the LAD. This may have been due to the different intramural vs. epicardial volume distribution of these vessels and a decrease in intramural tension during increased PCP. Increased PCP decreased LCX capacitance by approximately 13%, but no changes in conductance or zero flow pressure intercept occurred in any of the three vessels, i. e., evidence against the waterfall theory of vascular collapse at these levels of PCP. Coronary arterial capacitance was also linearly related to perfusion pressure.

  3. Thrombosed aneurysm of saphenous vein coronary artery bypass grafting

    Energy Technology Data Exchange (ETDEWEB)

    Queiroz, Rodolfo Mendes; Nastri Filho, Rogerio; Ferez, Marcus Antonio; Costa, Mauro Jose Brandao da; Laguna, Claudio Benedini; Valentin, Marcus Vinicius Nascimento, E-mail: rod_queiroz@hotmail.com [Documenta - Hospital Sao Francisco, Ribeirao Preto, SP (Brazil). Departamento de Radiologia e Diagnostico por Imagem; Hospital Sao Francisco, Ribeirao Preto, SP (Brazil). Centro de Terapia Intensiva

    2017-06-15

    We describe the case of a male patient, aged 76 years, referred for cardiac investigation due to retrosternal chest pain and dyspnea. He had a history of acute myocardial infarction and angioplasties in the last 30 years, including a saphenous vein coronary artery bypass grafting (SVCABG). Echocardiogram showed hypoechoic oval formation near the right ventricle, suggesting a pericardial cyst. Computed angiotomography revealed a predominantly fusiform and thrombosed aneurysmal dilation of the SVCABG to the right coronary artery. SVCABG aneurysms are very rare and potentially fatal. They usually appear in the late postoperative period, and patients are often asymptomatic. On radiography, it is frequently presented as enlargement of the mediastinum, with echocardiography, computed tomography and magnetic resonance imaging being very useful for diagnosis. Coronary angiography is the gold standard to detect these cases. Our report illustrates a rare situation arising late from a relatively common surgery. Due to its severity, proper recognition in the routine assessment of patients with a similar history is essential. (author)

  4. Coronary artery disease and its association with Vitamin D deficiency

    Directory of Open Access Journals (Sweden)

    Ramesh Aggarwal

    2016-01-01

    Full Text Available Coronary artery disease (CAD has become the latest scourge of humankind and referred to in this article as CAD, is the end result of the accumulation of atheromatous plaques within the walls of coronary arteries that supply the myocardium, a process also known as atherosclerosis and manifests mostly in the form of chronic stable angina or acute coronary syndrome. Vitamin D has attracted considerable interest recently due to its role in a number of extraskeletal disease processes including multiple sclerosis, malignancies, diabetes mellitus, and CAD. It is also known as sunshine vitamin due to its production in the body following exposure to ultraviolet rays, and it is a unique vitamin as it acts like a hormone with its receptor present in a wide range of tissues including endothelium, which is the important mediator of atherosclerosis and subsequent CAD. A large number of studies conducted in the past have provided the basic scientific framework and this article attempts to explore the role of Vitamin D deficiency in the pathogenesis of CAD and stresses the need for further research to fill up gap in our knowledge.

  5. Diagnosis of coronary artery disease in hypertensive patients

    International Nuclear Information System (INIS)

    Cuocolo, A.; Esposito, S.; Acampora, C.; Squame, C.

    1988-01-01

    Exercise radionuclide ventriculography (ERV) is considered a superior non-invasive screening test for coronary artery disease (CAD). ERV showed, however, a low specificity in hypertensive patients (H). The diagnostic accuracy of EAR and thallium-201 myocardial scintigraphy (M) was evaluated in 23 patients (H) with chest pain and positive ECG-strees test. All patients underwent ERV and M, randomly, in different days. Finally, they all underwent coronary angiography: CAD was diagnosed in case of luminal narrowing ≥ 70% in 1 major coronary artery at least. Eleven patients had severe CAD. ERV was considered positive for CAD in presence of ex-induced abnormality of wall motion and/or in case of ex-induced ejection fraction increase ≤ 5% respect to the basal values. M was considered positive for CAD when perfusion defects were observed in early images only. ERV showed low diagnostic accuracy. On the contrary M had both sensibility and specificity, and a high positive and negative predictive value in the diagnosis of CAD. M is thus suggested as the non-invasive methodology of choice in hypertensive patients with suspected CAD

  6. Coexistent coronary artery disease or myocardial bridging in patients with hypertrophic cardiomyopathy using coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Hwan; Chun, Eun Ju; Kim, Yeo Koon; Yoo, Jin Young; Choi, Sang Il; Choi, Dong Ju [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-07-15

    To evaluate the prevalence of coexistent coronary artery disease (CAD) or myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) using coronary CT angiography (CCTA) and assess the role of CCTA. The prevalence of obstructive CAD (> 50% luminal reduction) and MB (partial and full encasement) were assessed in 150 patients with HCM diagnosed by clinical findings, electrocardiography, and echocardiography of 19588 consecutive patients who underwent CCTA for suspected CAD. The overall feasibility of coronary artery visualization was 98.9% with CCTA. In patients with HCM, the prevalence of obstructive CAD and MB (14.7% partial and 28.0% full encasement) were 23.3% and 42.7%, respectively. Age, hypertension, family history of premature CAD, Framingham risk score and severe chest pain were associated with CAD, whereas male gender and septal type were associated with MB (all p < 0.05). In comparison to invasive coronary angiography (n = 37), the diagnostic accuracy of CCTA for the detection of CAD and full encasement MB was 89.2% and 86.5%, respectively. One-quarter of patients with HCM had coexistent obstructive CAD or full encasement MB. CCTA can be a feasible and accurate noninvasive imaging modality for the detection of CAD and MB in patients with HCM.

  7. Quantification of coronary artery calcium on the basis of dual-energy coronary CT angiography.

    Science.gov (United States)

    Schwarz, Florian; Nance, John W; Ruzsics, Balazs; Bastarrika, Gorka; Sterzik, Alexander; Schoepf, U Joseph

    2012-09-01

    To evaluate the feasibility of using virtual noncontrast material-enhanced (VNC) computed tomographic (CT) series derived from dual-energy CT imaging studies for coronary artery calcium quantification. This HIPAA-compliant study was institutional review board approved; all patients provided written informed consent. Thirty-six patients prospectively underwent noncontrast-enhanced CT calcium scoring followed by coronary CT angiography performed in dual-energy mode. By using different reconstruction algorithms, three VNC series were generated and evaluated for noise and efficiency of virtual iodine removal. Two readers independently quantified calcium on VNC images and true noncontrast-enhanced conventional calcium scoring series. A leave-one-out cross validation was used to assess the accuracy of calcium score prediction from VNC series by means of linear regression. CT value histograms of the VNC series closely resembled the profile in the true noncontrast-enhanced series. There was excellent correlation between calcium volumes on the VNC series and true noncontrast-enhanced series on a per-patient (r = 0.94, P VNC series was excellent (r = 0.82). Multiethnic Study of Atherosclerosis rankings that were derived from the predicted calcium scores also showed excellent agreement (intraclass correlation coefficient = 0.909). Coronary artery calcium identification and quantification based on dual-energy coronary CT angiographic studies may obviate the need for dedicated CT calcium scoring studies. © RSNA, 2012

  8. Myocardial imaging by direct injection of thallium-201 into coronary artery

    International Nuclear Information System (INIS)

    Sugihara, Hiroki; Inagaki, Suetsugu; Kubota, Yasushi

    1988-01-01

    Myocardial perfusion images were evaluated by direct injection of Thallium (Tl)-201 into coronary artery. Approximately 0.5 - 1 mCi of Tl-201 were instilled into the right coronary artery and/or the left coronary artery after coronary arteriography. Three images were obtained in the anterior, left anterior oblique and left lateral projections. Myocardial perfusion images of single photon emission computed tomography were also acquired in some patients. An image of supreme quality could be obtained in spite of small dose of Tl-201 since there was a lack of interference from background activity. Myocardial perfusion images corresponded to areas which were supplied by left or right coronary artery respectively. And the regional myocardial blood flow distribution of a coronary artery bypass graft could be revealed by instilling Tl-201 into the graft. Further, contribution of collateral channels to myocardial perfusion was showed. Not only left ventricle but also right ventricle was clearly visualized by injection of Tl-201 into right coronary artery. But in a case with arrhythmogenic right ventricular dysplasia, there was an area of decreased tracer uptake in the apex of the right ventricle which was identified as the site of dysplasia by electrophysiologic study. We conclude that direct injection of Tl-201 into coronary artery is an useful method to clarify the correlation between coronary anatomical findings and coronary perfusion and contribution of collaterals to myocardial perfusion, and also to detect the right ventricular myopathic site. (author)

  9. Congenital Left Circumflex Coronary Artery Atresia Detected by 64-Slice Computed Tomography: A Case Report

    Directory of Open Access Journals (Sweden)

    Chen-Yuan Liu

    2007-06-01

    Full Text Available A variety of coronary artery disorders, including intramyocardial coronary segments and coronary artery anomalies, can result in sudden cardiac death, especially in young adults. The detection of structural coronary artery abnormalities is important in the management of patients at risk of sudden cardiac death. Coronary artery anomalies occur in about 1% of the population. Congenital absence of left circumflex coronary artery (LCX is a very rare vascular anomaly, and few cases have been reported in the literature, with a frequency of only 0.003% in all patients who underwent coronary angiography. Although coronary catheterization is the gold standard for the evaluation of coronary arterial patency disease, noninvasive computed tomography (CT is considered the diagnostic method of choice for the detection and evaluation of coronary artery anomaly. Herein, we report the case of a 17-year-old girl who presented with exertional dyspnea and chest pain and who was studied at our emergency department with the final diagnosis of LCX atresia detected by 64-slice CT. She may be the first case of congenital LCX atresia proved by multislice CT.

  10. Effects of nicorandil on coronary collateral circulation depend on the donor arteries

    International Nuclear Information System (INIS)

    Umezawa, Shigeo; Ogawara, Shigeko; Okamoto, Yoshihiro; Igawa, Masayuki; Aonuma, Kazutaka; Inada, Mihoe; Korenaga, Masayoshi; Hiroe, Michiaki; Marumo, Fumiaki.

    1996-01-01

    The effects of nicorandil on coronary collateral circulation during exercise-induced ischemia were compared between the different donor arteries in 13 patients with effort angina, 7 with complete obstruction of the left anterior descending artery (LAD) with well-developed collateral vessels from the right coronary artery (RCA) (LAD group), and 6 with complete occlusion of the RCA (segment 2-3) with well-developed collateral vessels from the LAD (RCA group). Initial percentage thallium (%Tl) uptake (thallium-201 single photon emission computed tomography) and washout rate were measured in the anterior, septal and posterior regions during ergometer exercise. The submaximal treadmill exercise test was also performed using a cardiopulmonary monitoring system to measure Vo 2 at anaerobic threshold (AT). After the controls were obtained, nicorandil (15 mg/day) was administered for 4 weeks, during which ergometer exercise and treadmill exercise tests were carried out repeatedly. A significant improvement of initial %Tl uptake on exercise was observed in the LAD group with nicorandil therapy, but no improvement was shown in the RCA group. The AT significantly increased after nicorandil treatment in the LAD group (13.9±0.38 → 16.8±1.18 ml/min/kg), reflecting the improvement of cardiac function through the increased collateral flow. However, in the RCA group, it remained unchanged, suggesting no improvement of cardiac function. Nicorandil was effective to increase collateral flow from the RCA, but ineffective on that from the LAD. Nicorandil is an effective coronary dilator and is reported to affect both large and small coronary arteries. The effect on the collateral circulation is dependent on the donor artery supplying different areas. The vasodilator effect of nicorandil is mainly on the LAD, which is large enough to supply blood to a wider area of the heart, rather than the RCA. (author)

  11. Anomalous Aortic Origin of Coronary Arteries in the Young: Echocardiographic Evaluation With Surgical Correlation.

    Science.gov (United States)

    Lorber, Richard; Srivastava, Shubhika; Wilder, Travis J; McIntyre, Susan; DeCampli, William M; Williams, William G; Frommelt, Peter C; Parness, Ira A; Blackstone, Eugene H; Jacobs, Marshall L; Mertens, Luc; Brothers, Julie A; Herlong, J René

    2015-11-01

    This study sought to compare findings from institutional echocardiographic reports with imaging core laboratory (ICL) review of corresponding echocardiographic images and operative reports in 159 patients with anomalous aortic origin of a coronary artery (AAOCA). The study also sought to develop a "best practice" protocol for imaging and interpreting images in establishing the diagnosis of AAOCA. AAOCA is associated with sudden death in the young. Underlying anatomic risk factors that can cause ischemia-related events include coronary arterial ostial stenosis, intramural course of the proximal coronary within the aortic wall, interarterial course, and potential compression between the great arteries. Consistent protocols for diagnosing and evaluating these features are lacking, potentially precluding the ability to risk stratify patients based on evidence and plan surgical strategy. For a prescribed set of anatomic AAOCA features, percentages of missing data in institutional echocardiographic reports were calculated. For each feature, agreement among institutional echocardiographic reports, ICL review of images, and surgical reports was evaluated using the weighted kappa statistic. An echocardiographic imaging protocol was developed heuristically to reduce differences between institutional reports and ICL review. A total of 13%, 33%, and 62% of echocardiograms were missing images enabling diagnosis of intra-arterial course, proximal intramural course, and high ostial takeoff, respectively. There was poor agreement between institutional reports and ICL review for diagnosis of origin of coronary artery, interarterial course, intramural course, and acute angle takeoff (kappa = 0.74, 0.11, -0.03, 0.13, respectively). Surgical findings were also significantly different from those of reports, and to a lesser extent ICL reviews. The resulting protocol contains technical recommendations for imaging each of these features. Poor agreement between institutional reports and

  12. Gender difference and characteristics attributed to coronary artery disease in Gaza-Palestine.

    Science.gov (United States)

    Jamee, Amal; Abed, Yehia; Jalambo, Marwan O

    2013-05-26

    Traditionally coronary artery disease (CAD) has been considered as disease affecting men, and for long time women were not included in researches programme. In both sexes, coronary heart disease risk increases with age. Extensive clinical and statistical studies have identified serial factors that increase the risk of coronary heart disease, some of them can be modified, and some cannot. This study was performed to analyze the extent to which cardiovascular risk factors can explain the gender difference in coronary heart disease. The study design is a cross sectional study based on 155 cardiac patients admitted to cardiology department in Al-shifa hospital Gaza. The following cardiac risk factors were determined from the patient's records, smoking, diabetes, high blood pressure, Dyslipedemia and presence of family history of coronary artery disease. Catheterization results review were done. Statistical Package for Social Science version 17 was used for data entry and analysis. Frequency and cross tabulation were done to explore the relationship between the study variables. Chi-square test was used for testing statistical and P-value less than 0.05 were considered as significant. Most of risk factors were more favorable in females and increase with age. Myocardial infarction in male compared with female was 2 times higher, and chronic angina pain is common in female than male respectively 71.4% and 46.7%. Around 77% of female have two vessels disease and more. No great differences in number of diseased vessels among patients with myocardial infarction or chronic stable angina. Patients with low EF <50% have higher chance of affected vessels (82.9%). CAD stay the major problem in male and female, certain patient's characteristics and clinical conditions may place female at higher risk of coronary artery disease development or progression. This article addresses emerging knowledge regarding gender differences in CAD risk factors and responsiveness to risk reduction

  13. Anomalous aortic origin of a coronary artery: a report from the Congenital Heart Surgeons Society Registry.

    Science.gov (United States)

    Poynter, Jeffrey A; Williams, William G; McIntyre, Susan; Brothers, Julie A; Jacobs, Marshall L

    2014-01-01

    Anomalous aortic origin of a coronary artery (AAOCA) is a common congenital heart lesion that may be rarely associated with myocardial ischemia and sudden death in the young. Evidence-based criteria for managing young patients with AAOCA are lacking. The Congenital Heart Surgeons Society (CHSS) established a multicenter registry of patients with AAOCA aged ≤30 years to develop these criteria. All institutional members of the CHSS are eligible to enroll patients. Patients were enrolled retrospectively if diagnosis of AAOCA occurred between January 1, 1998, and January 20, 2009, and prospectively from January 20, 2009 forward. The first phase of analysis explored possible associations between demographics, symptoms, coronary anatomy, and management using correlation analysis and logistic regression. As of June 2012, 198 patients were enrolled from CHSS member institutions (median age at diagnosis = 10.2 years; 64% male). Data were extracted from clinical records. Fifty-four percent were symptomatic at presentation (most commonly chest pain, N = 78). The AAOCA was diagnosed at autopsy in two patients who presented with sudden death (one with anomalous aortic origin of the left coronary artery [AAOLCA]; one with a single ostium above a commissure giving rise to both left and right coronary arteries). Imaging reports documented anomalous aortic origin of the right coronary artery (AAORCA) in 144 patients, AAOLCA in 51 patients, and AAOLCA/AAORCA in 1 patient. Surgery or autopsy without surgery was performed in 106 patients (71 AAORCA [67%]; 31 AAOLCA [29%]; and 4 AAORCA/AAOLCA [4%]) at a median age of 12.6 years. Overall, 52% of patients with AAORCA versus 67% with AAOLCA had surgery. Most surgical operative reports described an intramural segment of the coronary artery with anomalous origin. Surgery correlated with symptoms, older age, and presence of an intramural segment in the setting of AAOLCA. Management decisions, including surgical referral, are associated

  14. Coronary artery assessment by multidetector computed tomography in patients with prosthetic heart valves

    International Nuclear Information System (INIS)

    Habets, Jesse; Mali, Willem P.T.M.; Budde, Ricardo P.J.; Brink, Renee B.A. van den; Uijlings, Ruben; Spijkerboer, Anje M.; Chamuleau, Steven A.J.

    2012-01-01

    Patients with prosthetic heart valves may require assessment for coronary artery disease. We assessed whether valve artefacts hamper coronary artery assessment by multidetector CT. ECG-gated or -triggered CT angiograms were selected from our PACS archive based on the presence of prosthetic heart valves. The best systolic and diastolic axial reconstructions were selected for coronary assessment. Each present coronary segment was scored for the presence of valve-related artefacts prohibiting coronary artery assessment. Scoring was performed in consensus by two observers. Eighty-two CT angiograms were performed on a 64-slice (n = 27) or 256-slice (n = 55) multidetector CT. Eighty-nine valves and five annuloplasty rings were present. Forty-three out of 1160 (3.7%) present coronary artery segments were non-diagnostic due to valve artefacts (14/82 patients). Valve artefacts were located in right coronary artery (15/43; 35%), left anterior descending artery (2/43; 5%), circumflex artery (14/43; 32%) and marginal obtuse (12/43; 28%) segments. All cobalt-chrome containing valves caused artefacts prohibiting coronary assessment. Biological and titanium-containing valves did not cause artefacts except for three specific valve types. Most commonly implanted prosthetic heart valves do not hamper coronary assessment on multidetector CT. Cobalt-chrome containing prosthetic heart valves preclude complete coronary artery assessment because of severe valve artefacts. circle Most commonly implanted prosthetic heart valves do not hamper coronary artery assessment circle Prosthetic heart valve composition determines the occurrence of prosthetic heart valve-related artefacts circle Bjoerk-Shiley and Sorin tilting disc valves preclude diagnostic coronary artery segment assessment. (orig.)

  15. The efficacy of hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency.

    Science.gov (United States)

    Zhai, Hongxia; Li, Liang; Yin, Yaxin; Zhang, Jinjin; Chen, Haiwei; Liu, Runmei; Xia, Yun-feng

    2016-01-01

    The aim of this study was to explore the efficacy and safety of hemodialysis in interventional therapy for patients with coronary artery disease combined with chronic renal insufficiency. With the aging and social development, the number of coronary artery disease patients with chronic renal insufficiency gradually increased. Total 58 coronary heart disease patients with chronic renal dysfunction were selected. These patients were characterized with typical angina symptoms and typical electrocardiogram (ECG) changes of onset angina. Continuous oral administration of sodium bicarbonate tablets 1 g 3/day × 3 days and slow intravenous input sodium chloride 1000 ∼1500 mL 3-12 h before operation were given. By this way, all patients were treated by hydration and alkalization. After percutaneous coronary intervention (PCI) treatment, patients were immediately transferred to undergo 4 h of dialysis treatment without removing indwelling of femoral artery puncture sheath tube to protect renal function. Changes in renal function including serum creatinine, glomerular filtration rate, and urine were observed and recorded. All patients were successfully underwent PCI treatment. Within one month after PCI, there were no obvious complication and no stent thrombosis occurred. Among of 58 patients, 56 cases showed no significant increase in serum creatinine levels compared with those before operation. However, serum creatinine level of one patient increased to 251 umol/L and one patient still required permanent dialysis. Using hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency could significantly improve the prognosis of the patients.

  16. Effect of stenosed and occluded coronary arteries on immediate and late myocardial uptake of thallium-201.

    Science.gov (United States)

    Clitsakis, D; Layton, C A; Battersby, W; Johns, M; Stockley, A V

    1981-01-01

    Exercise and redistribution myocardial scintigraphy using thallium-201 was compared with the left ventricular angiogram and with the presence of stenosis or occlusion of coronary arteries on angiography. Irreversible scintigraphic defects representing areas of myocardial infarction were found in all patients with occlusion of the left anterior descending artery but nearly one-third of patients with stenosis of that artery also showed evidence of infarction. For the right coronary or circumflex arteries the incidence of infarction was 82% with vessel occlusion and 57% with vessel stenosis. Of abnormally contracting segments on the left ventricular angiogram, 95% showed irreversible scintigraphic defects but 33% of normally contracting segments supplied by a diseased artery also showed this. Myocardial infarction is not uncommon in patients with angina even in the absence of coronary occlusion. The incidence is underestimated by the left ventricular angiogram. These findings are of importance in the assessment of patients with coronary disease and their evaluation before coronary artery surgery. PMID:7272129

  17. Friable but treatable: coronary artery dissections in Ehlers-Danlos syndrome.

    Science.gov (United States)

    Zago, Alexandre C; Matte, Bruno S

    2013-01-01

    Vascular Ehlers-Danlos syndrome is a rare connective tissue disorder associated with arterial dissection or rupture. Percutaneous coronary intervention (PCI) is often critical in patients with this syndrome because their coronary arteries are prone to dissection, enhancing the risk of stent borders dissection when conventional stent deployment pressures are used. Coronary artery bypass graft (CABG) treatment for these patients may also raise concerns because the left internal mammary artery is probably friable. Therefore, coronary artery revascularization in vascular Ehlers-Danlos syndrome either using PCI or CABG is challenging due to the arteries friability. A small number of cases have been published describing the friability of the vessels and associated complications; nevertheless, the optimum treatment remains unclear. We report the case of a 54-year-old woman treated successfully with PCI and CABG in two different acute coronary syndrome episodes, in which specific technical issues related to both procedures were decisive. Copyright © 2011 Wiley Periodicals, Inc.

  18. The usefulness of planar thallium myocardial perfusion imaging in the diagnosis of coronary artery disease

    International Nuclear Information System (INIS)

    Johannesen, K.A.; Andersen, K.; Foelling, M.; Vik-Mo, H.

    1991-01-01

    Stress thallium scintigraphy was performed in 60 patients with chest pain of uncertain origin. Myocardial ischemia was identified in 91% og the 47 patients who had angiographically significant coronary artery stenosis. Sensitivity of thallium scintigraphy was highest in patients with stenosis in the left descending coronary artery (LAD); 91% of the patients had abnormal thallium as compared with 67% of the patients with normal LAD, but significant stenosis in the circumflex artery and/or the right coronary artery. Perfusion defects in the circumflex or right coronary artery regions were detected in only 50% of the patients with multiple vessel disease. The authors conclude that stress thallium scintigraphy is a useful diagnostic procedure in patients with chest pain of uncertain origin and identifies the patients to be selected for coronary artery angiography. 15 refs., 2 figs., 2 tabs

  19. Axillary artery to left anterior descending coronary artery bypass with an externally stented graft: a technical report

    Directory of Open Access Journals (Sweden)

    Salvador Loris

    2008-02-01

    Full Text Available Abstract With the proliferation of minimally invasive cardiac surgery a number of alternative inflow sites for coronary artery bypass grafting have been utilized, especially in higher risk patients. The use of axillary-coronary artery bypass is a safe and effective alternative especially in the case of patients requiring redo coronary revascularization. However, the length and convoluted course of the axillary-coronary vein graft makes is susceptible to twisting, trauma and neointimal hyperplasia. We therefore report a case of an axillary-coronary artery bypass in a high risk patient in which a Dacron conduit was used to externally support and protect the vein graft to the left anterior descending artery. Surgical technique and considerations are presented and discussed.

  20. Coronary artery calcification detected by a mobile helical CT unit in a mass screening. The frequency and relationship to coronary risk factors and coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Itani, Yasutaka; Watanabe, Shigeru; Masuda, Yoshiaki [Chiba Univ. (Japan). School of Medicine; Hanamura, Kazuhisa; Asakura, Kazuhiro; Sone, Shusuke; Sunami, Yuko; Shimura, Akimitsu; Miyamoto, Tadaaki

    2001-06-01

    A strong relationship is known to exist between coronary artery disease (CAD) and coronary artery calcification (CAC) detected by CT. In this study, we investigated the frequency of CAC and the relationship between coronary risk factors, CAD and CAC in a mass screening using a mobile helical CT unit. The total number of participants was 10008 people undergoing a medical examination for lung cancer and tuberculosis using a mobile helical CT unit. We measured the CT density of the coronary artery to detect CAC. The CT density threshold for determining CAC was above +110HU. The frequency of CAC was 16.0% in the overall patient population and significantly higher in males than in females (20.6% vs 10.7%). Frequency increased with age in both genders. Hypertension and diabetes mellitus were significantly related to CAC. Smoking showed a correlation with CAC only in males. A significant relationship was observed between CAD and CAC in males. In particular, the relationship between them was strongest in males under 60 years of age. Furthermore, the odds ratio of CAC in predicting CAD increased with increasing risk factors in both genders. (author)

  1. Left ventricular diastolic function in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Brugger, P.T.

    1986-01-01

    In 302 patients with confirmed coronary disease we determined the left ventricular diastolic function with the Nuclear Stethoscope by the aid of the Peak Filling Rate (PFR) and the Time to Peak Filling Rate (TPFR). Moreover we investigated the ejection fraction (EF). 201 patients had already suffered a myocardial infarction, of these 99 an anterior wall and 102 an inferior wall infarction. The remaining 101 patients had a CAD without a history of myocardial infarction. The PFR was 2.19 ± 0.65 EDV/sec in the 99 patients after anterior wall infarction and 2.62 ± 0.85 EDV/sec in the 102 patients after inferior wall infarction and 2.79 ± 0.85 EDV/sec in 101 patients with coronary artery disease without a history of myocardial infarction. For the PFR there could be found a statistically significant difference between normal patients and patients after anterior wall infarction (p [de

  2. Coronary artery disease confined to secondary branches of the left coronary system

    International Nuclear Information System (INIS)

    Iskandrian, A.S.; Klein, B.L.; Segal, B.L.; Kimbiris, D.; Bemis, C.E.

    1981-01-01

    Among 3,000 patients studied by coronary arteriography during a 4-year period, 31 patients (1%) had coronary artery disease limited to a diagonal branch of the left anterior descending (15 patients), marginal branch of the left circumflex (10 patients), or to both branches (6 patients). Ten patients had 50-69% and twenty-one had greater than or equal to 70% diameter narrowing. The suitability for grafting was noted in 20 patients as judged by the caliber and distribution of the diseased branches. Collaterals were noted in seven patients. Disease was present in 28 men and 3 women (age range 38-70 years). At least one major coronary risk factor was present in 27 patients. Angina was noted in 27 patients; prior myocardial infarction was noted in 5 patients by history and in 4 by ECG. The left ventriculogram was normal in 22 patients and showed mild segmental asynergy in 9; ejection fraction was normal in all. Exercise ECGs were positive in 12 of 25 patients; exercise 201thallium scans were positive in 13. All patients responded to medical therapy. In conclusion, among the population of patients who undergo catheterization, coronary branch disease is rare. The clinical findings are indistinguishable from patients with major coronary disease. Prognosis remains benign and patients respond to medical therapy

  3. Right ventricular ejection fraction during exercise in normal subjects and in coronary artery disease patients: assessment by multiple-gated equilibrium scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Maddahi, J.; Berman, D.S.; Matsuoka, D.T.; Waxman, A.D.; Forrester, J.S.; Swan, H.J.C.

    1980-07-01

    The response of right ventricular ejection fraction (RVEF) during exercise and its relationship to the location and extent of coronary artery disease are not fully understood. We have recently developed and validated a new method for scintigraphic evaluation of RVEF using rapid multiple-gated equilibrium scintigraphy and multiple right ventricular regions of interest. The technique has been applied during upright bicycle exercise in 10 normal subjects and 20 patients with coronary artery disease. Resting RVEF was not significantly different between the groups (0.49 +- 0.04 vs 0.47 +- 0.09, respectively, mean +- SD). In all 10 normal subjects RVEF rose (0.49 +- 0.04 to 0.66 +- 0.08, p < 0.01) at peak exercise. At peak exercise in coronary artery disease patients, the group RVEF remained unchanged (0.47 +- 0.09 to 0.50 +- 0.11, p = NS), but the individual responses varied. In the coronary artery disease patients, the relationship between RVEF response to exercise and exercise left ventricular function, septal motion and right coronary artery stenosis were studied. Significant statistical association was found only between exercise RVEF and right coronary artery stenosis. RVEF rose during exercise in seven of seven patients without right coronary artery stenosis (0.42 +- 0.06 to 0.58 +- 0.08, p = 0.001) and was unchanged or fell in 12 of 13 patients with right coronary artery stenosis (0.50 +- 0.09 to 0.45 +- 0.10, p = NS). We conclude that (1) in normal subjects RVEF increases during upright exercise and (2) although RVEF at rest is not necessarily affected by coronary artery disease, failure of RVEF to increase during exercise, in the absence of chronic obstructive pulmonary disease or valvular heart disease, may be related to the presence of significant right coronary artery stenosis.

  4. Right ventricular ejection fraction during exercise in normal subjects and in coronary artery disease patients: assessment by multiple-gated equilibrium scintigraphy

    International Nuclear Information System (INIS)

    Maddahi, J.; Berman, D.S.; Matsuoka, D.T.; Waxman, A.D.; Forrester, J.S.; Swan, H.J.C.

    1980-01-01

    The response of right ventricular ejection fraction (RVEF) during exercise and its relationship to the location and extent of coronary artery disease are not fully understood. We have recently developed and validated a new method for scintigraphic evaluation of RVEF using rapid multiple-gated equilibrium scintigraphy and multiple right ventricular regions of interest. The technique has been applied during upright bicycle exercise in 10 normal subjects and 20 patients with coronary artery disease. Resting RVEF was not significantly different between the groups (0.49 +- 0.04 vs 0.47 +- 0.09, respectively, mean +- SD). In all 10 normal subjects RVEF rose (0.49 +- 0.04 to 0.66 +- 0.08, p < 0.01) at peak exercise. At peak exercise in coronary artery disease patients, the group RVEF remained unchanged (0.47 +- 0.09 to 0.50 +- 0.11, p = NS), but the individual responses varied. In the coronary artery disease patients, the relationship between RVEF response to exercise and exercise left ventricular function, septal motion and right coronary artery stenosis were studied. Significant statistical association was found only between exercise RVEF and right coronary artery stenosis. RVEF rose during exercise in seven of seven patients without right coronary artery stenosis (0.42 +- 0.06 to 0.58 +- 0.08, p = 0.001) and was unchanged or fell in 12 of 13 patients with right coronary artery stenosis (0.50 +- 0.09 to 0.45 +- 0.10, p = NS). We conclude that (1) in normal subjects RVEF increases during upright exercise and (2) although RVEF at rest is not necessarily affected by coronary artery disease, failure of RVEF to increase during exercise, in the absence of chronic obstructive pulmonary disease or valvular heart disease, may be related to the presence of significant right coronary artery stenosis

  5. An evaluation of coronary artery lesions of Kawasaki disease and congenital heart disease using rotary three dimensional digital cardiovascular angiography

    International Nuclear Information System (INIS)

    Watanabe, Masanori; Ogawa, Shunichi; Kumazaki, Tatsuo; Hirayama, Tsuneo

    1994-01-01

    Congenital heart disease and the coronary artery lesions of children suffering from Kawasaki disease were evaluated by cardiovascular angiography using a newly developed rotary three-dimensional digital angiography method, and the usefulness of the device was examined. This method enable the observation of lesions from 144 directions within a 180 degree range depicting an image from optimal directions. In addition, the radiation exposure during one angiography was about one fifth of that of conventional cineangiography. With regard to the lesions of the coronary artery, identification of the localization of the stenotic lesions were made possible, especially at bifurcations, or the stenotic lesions overlapping with other bifurcations or coronary arteries aneurysms as well as the structure at the ostium of the left and right coronary arteries, which were difficult to identify using conventional coronary artery angiography. For the case of patient ductus arteriosus or major aortopulmonary collateral artery (MAPCA), separation and imaging of the overlap with other blood vessels through the three-dimensional observation became possible. This method is effective for the evaluation of the site, direction and morphology of these arteries. With regard to stenosis of the right ventricular outflow tract, the morphology and the degree of stenosis could be evaluated more accurately than by conventional cineangiography. In addition, the images matched well with the operative findings. This method was also effective for the diagnosis and evaluation of the stenosis at the main pulmonary artery and stenosis of the bifurcation of the right and left pulmonary arteries overlapping with the main trunk of the pulmonary artery. The problem with this method is that it cannot be used for the quantitative evaluation of the cardiac function because it cannot take images from multiple directions at the same time or cannot take temporal images from one direction. (author)

  6. The relation between intensity and complexity of coronary artery lesion and oxidative stress in patients with acute coronary syndrome.

    Science.gov (United States)

    Turan, Turhan; Menteşe, Ümit; Ağaç, Mustafa Tarık; Akyüz, Ali Rıza; Kul, Selim; Aykan, Ahmet Çağrı; Bektaş, Hüseyin; Korkmaz, Levent; Öztaş Menteşe, Seda; Dursun, İhsan; Çelik, Şükrü

    2015-10-01

    Oxidative stress plays a major role in the development of atherosclerosis. However, the relationship between oxidative stress and complexity and intensity of coronary artery disease is less clear. The aim of this study is to assess the relationship between oxidative stress markers and the complexity and intensity of coronary artery disease in patients with acute coronary syndrome (ACS). Sixty-seven consecutive patients with an early phase of ACS (=22). Likewise patients were divided into two CAD severity groups according to the median Gensini score of 64: less intensive CAD with Gensini score (=64. Blood samples were taken in 1 hour within administration in order to measure total oxidative status (TOS) and total antioxidant capacity (TAC) levels determined by Erel method. Oxidative stress index (OSI) was calculated by TOS /TAC. There was no significant difference between the two SYNTAX groups for oxidative stress markers. Median TOS and OSI values were significantly high in the intensive CAD group (p=0.005, p=0.04, respectively). The Gensini score was positively correlated with TOS and OSI (p=0.003, p=0.02, respectively). Oxidative stress markers may be considered supportive laboratory parameters related to CAD intensity but not complexity in ACS patients.

  7. New stent design for use in small coronary arteries during percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Juan F Granada

    2010-10-01

    Full Text Available Juan F Granada1, Barbara A Huibregtse2, Keith D Dawkins21The Jack H Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY, USA; 2Boston Scientific Corporation, Natick, MA, USAAbstract: Patients with diabetes mellitus, of female gender, increased age, and/or with peripheral vascular disease often develop coronary stenoses in small caliber vessels. This review describes treatment of these lesions with the paclitaxel-eluting 2.25 mm TAXUS® Liberté® Atom™ stent. Given the same stent composition, polymer, antirestenotic drug (paclitaxel, and release kinetics as the first-generation 2.25 mm TAXUS® Express® Atom™ stent, the second-generation TAXUS Liberté Atom stent incorporates improved stent design characteristics, including thinner struts (0.0038 versus 0.0052 inches, intended to increase conformability and deliverability. In a porcine noninjured coronary artery model, TAXUS Liberté Atom stent implantation in small vessels demonstrated complete strut tissue coverage compared with the bare metal stent control, suggesting a similar degree of tissue healing between the groups at 30, 90, and 180 days. The prospective, single-armed TAXUS ATLAS Small Vessel trial demonstrated improved instent late loss (0.28 ± 0.45 versus 0.84 ± 0.57 mm, P < 0.001, instent binary restenosis (13.0% versus 38.1%, P < 0.001, and target lesion revascularization (5.8% versus 17.6%, P < 0.001 at nine months with the TAXUS Liberté Atom stent as compared with the bare metal Express stent control, with similar safety measures between the two groups. The TAXUS Liberté Atom also significantly reduced nine-month angiographic rates of both instent late loss (0.28 ± 0.45 versus 0.44 ± 0.61 mm, P = 0.03 and instent binary restenosis (13.0% versus 25.9%, P = 0.02 when compared with the 2.25 mm TAXUS Express Atom control. The observed reduction in target lesion revascularization with the TAXUS

  8. Association between gamma-glutamyltransferase and coronary artery calcification.

    Science.gov (United States)

    Atar, Asli I; Yilmaz, Omer C; Akin, Kayihan; Selcoki, Yusuf; Er, Okan; Eryonucu, Beyhan

    2013-08-20

    The exact mechanisms behind the association between atherosclerosis and gamma-glutamyltransferase (GGT) are unclear. Coronary artery calcification (CAC) detected by computerized tomography is an important marker of atherosclerosis and its severity correlates with coronary plaque burden. The aim of this study was to investigate if serum GGT levels are associated with CAC in patients without known coronary heart disease (CHD) who had low-intermediate risk for CHD. Two hundred and seventy two patients who had low-intermediate risk for coronary artery disease were included in the study. Serum GGT levels were measured spectrophotometrically. CACS (Agatston method) were performed using a 64-slice computerized tomography scanner. The patients were grouped according to their GGT values in four quartiles. Patients in higher GGT quartiles had elevated CAC score (P<0.001). Patients in higher GGT quartiles were predominantly males (P<0.001) and were more likely to be smoking (P=0.004), and have elevated uric acid (P<0.001), fasting blood glucose (P<0.001), CRP levels (P=0.003) and 10-year total cardiovascular risk (P=0.007) and low HDL levels (P<0.001). Positive correlations were found between log GGT and CAC (r=0.233, P<0.001). In the multivariate analysis GGT, age, smoking and serum uric acid levels appeared as independent factors predictive of presence of CAC. We demonstrated a significant correlation between serum GGT levels and CAC and CHD risk factors. Serum GGT level was an independent marker of CAC. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  9. Left ventricular diastolic function in patients with coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Brugger, P.T.

    1986-08-01

    In 302 patients with confirmed coronary disease we determined the left ventricular diastolic function with the Nuclear Stethoscope by the aid of the Peak Filling Rate (PFR) and the Time to Peak Filling Rate (TPFR). Moreover we investigated the ejection fraction (EF). 201 patients had already suffered a myocardial infarction, of these 99 an anterior wall and 102 an inferior wall infarction. The remaining 101 patients had a CAD without a history of myocardial infarction. The PFR was 2.19 +- 0.65 EDV/sec in the 99 patients after anterior wall infarction and 2.62 +- 0.85 EDV/sec in the 102 patients after inferior wall infarction and 2.79 +- 0.85 EDV/sec in 101 patients with coronary artery disease without a history of myocardial infarction. For the PFR there could be found a statistically significant difference between normal patients and patients after anterior wall infarction (p < 0.0001), normal patients and patients after inferior wall infarction (p < 0.0001) and normal patients and patients with coronary artery disease (p < 0.0001). The TPFR was 180 +- 37.5 msec after anterior - and 158 +- 50.7 msec after inferior wall infarction and 156 +- 45.2 msec in the patients with CAD without previous infarction. The left ventricular diastolic function (PFR and/or TPFR) was abnormal in 88% after anterior- and in 82% after inferior wall infarction and in 69% in coronary patients without previous myocardial infarction. In comparison with this the ejection fraction was reduced in 66% in anterior- and in 61% inferior wall infarction at rest. These results indicate that the diastolic function at rest appears to be more informative for evaluation of a left ventricular dysfunction than the systolic function at rest.

  10. Isoproterenol stress thallium scintigraphy for detecting coronary artery disease

    International Nuclear Information System (INIS)

    Watanabe, Shigeyuki; Ajisaka, Ryuichi; Masuoka, Takeshi; Iida, Kaname; Sugishita, Yasuro; Ito, Iwao; Takeda, Tohru; Toyama, Hinako; Akisada, Masayoshi

    1989-01-01

    The present study was undertaken to assess the diagnostic value of isoproterenol (ISP) thallium scintigraphy. The findings were compared with those of ISP-ECG and exercise thallium scintigraphy. The study population consisted of 24 patients who had a history of chest pain without previous myocardial infarction. ISP was given at increasing doses of 0.02, 0.04, 0.08 μg/mg/min at 3-minutes intervals, and was terminated for any of the following reasons: angina, significant arrhythmia, significant ST segment depression, or target heart rate. Thallium scintigrams were obtained immediately after terminating ISP infusion, and after a 3-hour delay, redistribution scans were obtained. Scintigrams were considered positive when a reversible defect was present. After stress tests, coronary angiography was performed. According to the presence or absence of significant coronary artery stenosis, the patients were divided into coronary artery disease (CAD) group (n=12) and so-called normal coronary (NC) group (n=12). Among 12 patients in the CAD group, ISP induced anginal pain in six (50%), and ISP-ECT and ISP thallium scintigraphy were positive in 10 (83%) and in 11 (92%), compared with four(33%), four(33%) and two (17%) in the NC group. These data indicate that ISP-ECG had a sensitivity of 83%, a specificity of 67%, and a diagnostic accuracy of 75%; and the corresponding figures for ISP thallium scintigraphy were 92%, 83%, and 88%. Among nine patients who underwent both ISP thallium scintgraphy and exercise thallium scintigraphy, all patients, except for one false negative case on ISP thallium scintigraphy, were correctly diagnosed. No serious complications occurred in association with the ISP infusion test. ISP thallium scintigraphy was considered to be a safe, sensitive, and specific method for diagnosing CAD when exercise tests were intolerable. (N.K.)

  11. Coronary artery bypass grafting versus percutaneous intervention in coronary revascularization: a historical perspective and review

    Directory of Open Access Journals (Sweden)

    Burgess SN

    2015-06-01

    Full Text Available Sonya N Burgess,1 John J Edmond,2 Craig P Juergens,1 John K French11Department of Cardiology, Liverpool Hospital and South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; 2Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand Background: Coronary artery bypass graft surgery is arguably the most intensively studied surgical procedure, and percutaneous coronary intervention (PCI has been subjected to more randomized clinical trials than any other interventional procedure. Changes seen in revascularization techniques have been numerous. The rapid evolution of evidence-based revascularization procedures has occurred as a result of many pivotal large randomized clinical trials. Objective: This review compares and contrasts outcomes from two coronary revascularization techniques, coronary artery bypass grafting (CABG and PCI, with particular reference to the landmark trials that inform practice guidelines. Methods: We undertook a comprehensive review of published literature addressing trials in this field performed to address current knowledge both in the predrug-eluting stent and postdrug-eluting stent era. Results and discussion: Surgical and percutaneous revascularization strategies have different strengths and weaknesses, and neither strategy is superior in all patients, clinical presentations, or anatomical subgroups. Current data support the use of percutaneous intervention in ST elevation myocardial infarction and in single-vessel disease. In noncomplex multivessel disease and isolated left main stem PCI, the data support non-inferiority of PCI compared to CABG as reflected in the 2014 European Society of Cardiology guidelines. Landmark revascularization trials of multivessel disease comparing CABG to PCI found no survival benefit to CABG over PCI, except in patients with complex disease. In these trials, revascularization drove differences in primary endpoints and in all but the

  12. Detection of coronary artery calcification by ultrafast CT and correlation with angiography

    International Nuclear Information System (INIS)

    Zhang Shaoxiong; Dai Ruping; Lu Bin

    1997-01-01

    To investigate the relationship between coronary calcification and significant coronary stenosis ninety patients including 81 men and 9 women were studied asithage ranging from 27∼72 years (mean, 58 years). All patients had both ultrafast CT (UFCT) examination and coronary angiography within one month. Single slice mode with ECG gating and thickness of 3 mm were used in UFCT scan. Selected coronary angiography was performed by the Judkins technique. Among 160 vessels in which coronary calcifications were identified, 74% had significant coronary stenosis (>50% stenosis), and 77% of 154 vessels with significant coronary stenosis had calcification demonstrable by UFCT. In the younger age group the sensitivity of calcification for evaluating stenosis of coronary artery was lower and the specificity was generally higher than those in the elderly group. UFCT is a promising procedure for detecting coronary arterial disease, since this examination has high sensitivity and specificity, easy to conduct, noninvasive, and widely applicable for screening a large population

  13. COMPLEX CORONARY PATTERN AFFECTING THE SURGICAL OUTCOME OF ARTERIAL SWITCH OPERATION

    Directory of Open Access Journals (Sweden)

    Amit

    2015-12-01

    Full Text Available BACKGROUND Arterial switch operation (ASO has become the procedure of choice for the transposition of great arteries as well as for Taussig-Bing anomaly. Relocation of coronary arteries remains a technical problem in anatomic correction of the transposed great arteries. The present prospective study is designed to analyse the effect of coronary artery pattern on surgical outcome of arterial switch operation. METHOD From August 2014 to November 2015, total 60 patients underwent ASO. The patients are divided in three groups. Group-A 21 patients with d-TGA with intact ventricle septum (d-TGA intact IVS, in Group-B 33 patients d-TGA with ventricular septal defect (d-TGA, VSD, and in Group C 6 Taussig Bing anomaly. The coronary pattern and outcome is analyzed. RESULTS The overall mortality related to coronary pattern was 5%. The 2 patients died due to Intramural coronary artery leading to post-operative ventricular dysfunction, another patient with single retro pulmonary coronary artery died secondary to low coronary implant leading to kinking in coronary artery and myocardial dysfunction. On 12 monthly follow up, one of the Patients in group A had right pulmonary artery stenosis with gradient of 30 mm of Hg. Another patient in group B had supravalvular gradient of 20 mm of Hg. CONCLUSION The ASO for TGA and Taussig-Bing anomaly has low early and late mortality. However, the mortality is still seen in the patients with Intramural coronary artery and in the patient with single coronary artery with retro pulmonary course.

  14. The angiographic findings of coronary arterial spasm (a report of 37 cases)

    International Nuclear Information System (INIS)

    Kuang Jianyi; Chen Jianhun; Du Zhimin; Li Xiangmin; Hu Chengheng

    2002-01-01

    Objective: The arterial spasm which often seen in the coronary angiography was considered as a result of the pathological spasm of the coronary artery or a complication of catheterization. The coronary arterial spasm is a considerable situation because it increases the danger of stenotic lesions in coronary artery, which should be managed immediately. Methods: In total 37 patients presented with coronary arterial spasm in the coronary angiography (Judkins method): 23 male and 14 female, aged 43-60 years (the 47 years in average). Spasms were relieved in all patients after the administration of glonoin. Results: Solitary spasm were the most common, the angiographic findings were long section (>10 mm) with stenosis of 50%-65% in left anterior descending artery (12 cases), or in the middle and near portion of the right coronary artery (5 cases), where the orifice of the branches were involved; severe stenosis of the orifice of the right coronary artery (3 cases); irregular, mild and local spasm in left anterior descending artery or circumflex (8 cases). And multiple spasm was observed in left anterior descending artery (4 cases) or in the right coronary artery (5 cases). In 19 cases, stenosis accompanying with spasm were revealed and local spasm were observed at the site of arterial sclerosis. Conclusion: The spasm owing to the catheterization doesn't result in chest discomfort and changes in EKG, while pathological spasm occurs in the population with high risk of coronary heart disease, which indicates the potential myocardial infraction. The angiographic findings helps differentiating the two situation

  15. Peripheral vascular disease in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Bashir, E. A.; Aslam, N.

    2001-01-01

    Objective: The prevalence of peripheral vascular disease (PVD) in patients with coronary artery disease (CAD) has been investigated in many different ways. It depends on the diagnostic methods used and definition of atherosclerotic manifestations in the different vascular beds. This study was carried out to determine the prevalence of PVD in the lower limbs in group of patients with CAD. Design: This is a prospective observational study. Place and duration of study: The study was conducted at Combined Military Hospital/Armed Forces institute of Cardiology, Rawalpindi, over a period of one year (January 1998 to January 1999). Subjects and methods: A total number of 200 patient (171 male and 29 females) aged 55-77 years with CAD. Diagnosed by coronary angiography were included in the study. In all patients blood pressure was recorded in both arms by sphygmomanometer and ankle systolic pressure by Doppler ultrasound. Ankle branchial index was calculated. Demographic data were obtained from the patient's hospital files. Results: The prevalence of PVD was 22.5% in patients with CAD in agreement with the results of most previous investigation. There was tendency towards increasing prevalence of PVD with more advanced CAD. Thirty patients (27%) showed evidence of triple vessel disease as compared to 13 patient (18%) with double vessel and 2 patients (1%) with single vessel disease. Conclusion: A non-invasive investigation of peripheral arterial circulation should be included early in the clinical consideration of patients with chest pain or similar symptoms suggesting coronary artery disease. Ankle systolic pressure appears to be simple and cheap technique for evaluation of results. (author)

  16. Sudden Death Due to Coronary Artery Lesions Long-term After the Arterial Switch Operation: A Systematic Review.

    NARCIS (Netherlands)

    van Wijk, Sebastiaan W.H.; van der Stelt, Femke; ter Heide, Henriëtte; Schoof, Paul H.; Doevendans, Pieter A.F.M.; Meijboom, Folkert J.; Breur, Johannes M.P.J.

    2017-01-01

    Background The arterial switch operation (ASO) is the preferred procedure for children with dextrotransposition of the great arteries or Taussig-Bing anomaly. Short- as well as long-term outcome of ASO are excellent, but coronary artery stenoses are reported as a common long-term complication. It

  17. Coronary Flow Reserve Predicts Cardiopulmonary Fitness in Patients with Coronary Artery Disease Independently of Systolic and Diastolic Function

    DEFF Research Database (Denmark)

    Snoer, Martin; Olsen, Rasmus Huan; Monk-Hansen, Tea

    2014-01-01

    Aims Despite revascularization and optimal medical treatment, patients with coronary artery disease (CAD) have reduced exercise capacity. In the absence of coronary artery stenosis, coronary flow reserve (CFR) is a measure of coronary microvascular function, and a marker of future poor outcome...... in CAD patients. The aim of this study was to examine the relationship among CFR, systolic and diastolic function, peripheral vascular function, and cardiopulmonary fitness in CAD patients. Methods and Results Forty patients with median left ventricular ejection fraction (LVEF) 49 (interquartile 46....... Conclusions Coronary flow reserve measured noninvasively predicts cardiopulmonary fitness independently of resting systolic and diastolic function in CAD patients, indicating that cardiac output during maximal exercise is dependent on the ability of the coronary circulation to adapt to the higher metabolic...

  18. Return to the workforce following coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Butt, Jawad H; Rørth, Rasmus; Kragholm, Kristian

    2018-01-01

    Background Returning to the workforce after coronary artery bypass grafting (CABG) holds important socioeconomic consequences not only for patients, but the society as well. Yet data on this issue are limited. We examined return to the workforce and associated factors in patients of working age.......0%) patients had returned to the workforce, 614 (10.2%) were on paid sick leave, 267 (4.4%) received disability pension, 250 (4.1%) were on early retirement, 57 (0.9%) had died, and 16 (0.3%) had emigrated. Factors associated with return to the workforce were identified using multivariable logistic regression...

  19. Incidental invasive thymoma during coronary artery bypass surgery

    International Nuclear Information System (INIS)

    Al-Smady, Moaath M.; Hammdan, Farouq F.; Abu-Abeeleh, Mahmood M.; Massad, Islam M.

    2009-01-01

    We encountered 2 incidental cases of invasive thymomas at Jordan University Hospital, Amman, Jordan: during the routine coronary artery bypass graft surgery between 2005 and 2008 with an incidence of 0.6%. Both patients presented with angina pain. None of the 2 patients had pressure symptoms (cough, shortness of breath or superior vena cava syndrome) or Myasthenia Gravis symptoms. Total thyectomy with dissection of perithymic fat was performed on both cases. No radiotherapy was given. No recurrence of the tumor was seen in 2 years follow-up. These cases are presented to emphasize the occurrence of this tumor. (author)

  20. Cardiac nuclear medicine, part II: diagnosis of coronary artery diseas

    International Nuclear Information System (INIS)

    Polak, J.F.; Holman, B.L.

    1981-01-01

    Diagnosing coronary artery disease is difficult and requires careful consideration of the roles and limitations of the tests used. Standard ECG tests are not reliable indicators of the presence of disease in asymptomatic patients. Thallium stress testing to assess ischemia and exercise ventriculography to assess functional status of the heart are limited in sensitivity and specificity. This is the second of a three-part series on cardiac nuclear medicine. Part I (Med. Instrum., May-June, 1981) focused on the commonly used examinations in cardiac physiology and pathophysiology. Part III will focus on myocardial infarction and other cardiac diseases

  1. Transmural myocardial perfusion gradients in relation to coronary artery stenoses severity assessed by cardiac multidetector computed tomography

    DEFF Research Database (Denmark)

    Linde, Jesper James; Kühl, Jørgen Tobias; Hove, Jens Dahlgaard

    2015-01-01

    To assess the relationship between epicardial coronary artery stenosis severity and the corresponding regional transmural perfusion at rest and during adenosine stress, using multidetector computed tomography (MDCT). We evaluated the relationship between the severity of coronary artery diameter...

  2. The relationship between fractional flow reserve, platelet reactivity and platelet leukocyte complexes in stable coronary artery disease

    NARCIS (Netherlands)

    Sels, J.W.E.M.; Rutten, B.; Holten, van T.C.; Hillaert, M.A.K.; Waltenberger, J.; Pijls, N.H.J.; Pasterkamp, G.; Groot, de P.G.; Roest, M.

    2013-01-01

    Background: The presence of stenoses that significantly impair blood flow and cause myocardial ischemia negatively affects prognosis of patients with stable coronary artery disease. Altered platelet reactivity has been associated with impaired prognosis of stable coronary artery disease. Platelets

  3. Incidental finding of single coronary artery in a patient with alcoholic cardiomyopathy presenting as acute heart failure.

    Science.gov (United States)

    McNair, Patrick; Jones, Erica; Truong, Quynh; Singh, Harsimran

    Single coronary artery is a rare clinical finding. Diagnosis is typically made incidentally after the patient presents with symptoms and undergoes coronary angiography, coronary computed tomography angiography (CTA), or post-mortem during autopsy. Several high-risk features of anomalous coronary arteries have been described in the literature. Our paper describes a case of dilated alcoholic cardiomyopathy presenting as heart failure with diagnostic workup incidentally revealing single coronary artery. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Prognostic value of atherosclerotic burden and coronary vascular function in patients with suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Assante, Roberta; Zampella, Emilia; Nappi, Carmela; Mainolfi, Ciro Gabriele; Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Acampa, Wanda [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Institute of Biostructure and Bioimaging, National Council of Research, Naples (Italy); Arumugam, Parthiban; Tonge, Christine M. [Central Manchester University Teaching Hospitals, Nuclear Medicine Center, Manchester (United Kingdom); Gaudieri, Valeria; Panico, Mariarosaria; Magliulo, Mario [Institute of Biostructure and Bioimaging, National Council of Research, Naples (Italy); Petretta, Mario [University Federico II, Department of Translational Medical Sciences, Naples (Italy)

    2017-12-15

    To evaluate the prognostic value of coronary atherosclerotic burden, assessed by coronary artery calcium (CAC) score, and coronary vascular function, assessed by coronary flow reserve (CFR) in patients with suspected coronary artery disease (CAD). We studied 436 patients undergoing hybrid {sup 82}Rb positron emission tomography/computed tomography imaging. CAC score was measured according to the Agatston method, and patients were categorized into three groups (0, <400, and ≥400). CFR was calculated as the ratio of hyperemic to baseline myocardial blood flow, and it was considered reduced when <2. Follow-up was 94% complete during a mean period of 47±15 months. During follow-up, 17 events occurred (4% cumulative event rate). Event-free survival decreased with worsening of CAC score category (p < 0.001) and in patients with reduced CFR (p < 0.005). At multivariable analysis, CAC score ≥400 (p < 0.01) and CFR (p < 0.005) were independent predictors of events. Including CFR in the prognostic model, continuous net reclassification improvement was 0.51 (0.14 in patients with events and 0.37 in those without). At classification and regression tree analysis, the initial split was on CAC score. For patients with a CAC score < 400, no further split was performed, while patients with a CAC score ≥400 were further stratified by CFR values. Decision curve analyses indicate that the model including CFR resulted in a higher net benefit across a wide range of decision threshold probabilities. In patients with suspected CAD, CFR provides significant incremental risk stratification over established cardiac risk factors and CAC score for prediction of adverse cardiac events. (orig.)

  5. Normal myocardial perfusion imaging in the presence of significant coronary artery stenosis

    International Nuclear Information System (INIS)

    Tian Yueqin; He Zuoxiang; Fang Wei; Yang Minfu; Shen Rui

    2007-01-01

    Objective: The aim of this study was to investigate the factors which might result in normal myocardial perfusion imaging in the presence of significant coronary artery stenosis. Methods: One hundred and thirty-three patients [mean age of (59±10) years, 98 men, 35 women] who underwent coronary angiography and myocardial perfusion SPECT were retrospectively analyzed. Results: Forty-six (35%) patients performed adequate bicycle exercise testing and achieved more than 85% of their predicted maximal heart rates; while 87 (65%) patients did not. Eighty-four (63%) patients had single coronary stenosis, 31(23%) two-vessel and 17(13%) three-vessel diseases. The difference in stenosis severity among the vessels in 13 (76%) cases with three-vessel diseases was not more than 20%. There were totally 202 coronary artery stenosis: 93 (46%) in left anterior descending coronary artery (LAD), 52 (26%) left circumflex coronary artery (LCX), 52(26% ) right coronary artery (RCA) and 5 (2%) left main coronary artery (LM) disease. Eighty-six(43%) vessels had 50%-70% stenosis, 100 (49%) >70%-90% and 16(8% )more than 90%. Conclusion: Normal myocardial perfusion imaging with significant coronary artery stenosis can probably due to inadequate exercise, single vessel disease and mild to moderate stenotic lesion. (authors)

  6. Relationship between the arterial calcification detected in mammography and coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Topal, Ugur [Department of Radiology, Uludag University, Medical School, Goeruekle Campus, 16059 Bursa (Turkey)], E-mail: utopal@uludag.edu.tr; Kaderli, Aysel [Department of Cardiology, Uludag University, Medical School, Goeruekle Campus, 16059 Bursa (Turkey); Topal, Naile Bolca [Department of Radiology, Uludag University, Medical School, Goeruekle Campus, 16059 Bursa (Turkey); Ozdemir, Buelent; Yesilbursa, Dilek; Cordan, Jale [Department of Cardiology, Uludag University, Medical School, Goeruekle Campus, 16059 Bursa (Turkey); Ediz, Buelent [Department of Statistics, Uludag University, Medical School, Goeruekle Campus, 16059 Bursa (Turkey); Aydinlar, Ali [Department of Cardiology, Uludag University, Medical School, Goeruekle Campus, 16059 Bursa (Turkey)

    2007-09-15

    Objective: Arterial calcification is frequently encountered in mammography. The frequency of breast arterial calcification (BAC) increases with increasing age. Studies have shown that BAC is seen more frequently among the people who are under the risk of coronary artery diseases (CAD) such as diabetes and hypertension. The objective of this study is to investigate the relationship between the arterial calcification detected in mammography and the CAD. Material and methods: Screening mammography was performed in 123 women above the age of 40 years who had been examined with coronary angiography for the evaluation of CAD. The presence of BAC, number of affected vessels, and the distribution of calcification in the vessel wall were evaluated in the mammography. Subjects were questioned in terms of the cardiovasculary risk factors. The severity of CAD was evaluated according to the Gensini scoring. In addition, the number of blood vessels with stenosis of more than 50% was used as the vascular score. The correlation between Gensini and the vascular scores, and BAC was statistically evaluated using Mann-Whitney U and Kruskal-Wallis tests. Results: Eighty (65%) of 123 patients had CAD. BAC was detected in the mammography of 49 (39.8%) subjects. The ages and duration of menopause of the cases with BAC were significantly higher than those without BAC (p < 0.001). There was an almost significant correlation between the BAC and Gensini scores (p = 0.059). There was a significant increase in the frequency of BAC among subjects with more than two vessels with stenosis (p = 0.033). Conclusion: Frequency of BAC increases with increasing age. BAC is also frequently seen in subjects having severe coronary artery disease. Although increasing age may be a factor increasing the frequency of BAC, BAC may also be an indicator of CAD. Therefore, the mentioning of arterial calcification in mammography reports may be important in warning the clinician in terms of CAD.

  7. [THE INFLUENCE OF MONO- AND MULTIVASCULAR LESIONS OF CORONARY ARTERIES ON THE COURSE OF CORONARY HEART DISEASE IN PATIENTS WITH DIABETES MELLITUS TYPE 2].

    Science.gov (United States)

    Sypalo, A; Kravchun, P; Kadykova, O

    2017-03-01

    The article assesses the influence of mono- and multivascular lesions of coronary arteries on the course of coronary heart disease at patients with diabetes mellitus type 2. For this purpose, a comprehensive survey of 75 patients with coronary heart disease and diabetes mellitus type 2 was arranged. Depending on the number of vascular lesions of the coronary arteries, according to the data of coronary arteries computer tomography, all patients were divided into two subgroups. The first subgroup included 27 patients with coronary heart disease and diabetes mellitus type 2 with monovascular lesions of coronary arteries. To the second subgroup were included 48 patients with coronary heart disease and diabetes mellitus type 2 with multivascular lesions of coronary arteries. During the analysis of carbohydrate metabolism in cases of coronary heart disease and diabetes mellitus type 2 the HOMA index increase by 25.40% and insulin level increase by 17.05% were revealed at patients with multivascular lesions of coronary arteries in comparison with patients with monovascular lesions of coronary arteries, respectively. The combination of coronary heart disease and diabetes mellitus type 2 with multivascular lesions of coronary arteries was associated with an increase of sortilin level (233,47±47,85 ng/l). A significant increase in triglycerides, lipoprotein cholesterol of very low density influences greatly on the progression of coronary atherosclerosis with lesions of greater number of coronary arteries at patients surveyed. At patients with coronary heart disease and diabetes mellitus type 2 with multivascular lesions of coronary arteries the left ventricle myocardial re-modeling occurred through the increase of left ventricle's size and cavity.

  8. The prognostic value of coronary endothelial and microvascular dysfunction in subjects with normal or non-obstructive coronary artery disease

    DEFF Research Database (Denmark)

    Brainin, Philip; Frestad, Daria; Prescott, Eva

    2018-01-01

    AIMS: Coronary vascular dysfunction is linked with poor cardiovascular prognosis in patients without obstructive coronary artery disease (CAD) but a critical appraisal of the literature is lacking. METHODS AND RESULTS: We performed a systematic review and meta-analysis to quantify...

  9. Correlates and Impact of Coronary Artery Calcifications in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

    DEFF Research Database (Denmark)

    Giustino, Gennaro; Mastoris, Ioannis; Baber, Usman

    2016-01-01

    OBJECTIVES: The aim of this study was to investigate the clinical correlates and prognostic impact of coronary artery calcification (CAC) in women undergoing percutaneous coronary intervention with drug-eluting stents (DES). BACKGROUND: The clinical correlates and the prognostic significance of CAC...

  10. Coronary artery disease in patients undergoing cardiac surgery for non-coronary lesions in a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Cholenahally Nanjappa Manjunath

    2014-01-01

    Conclusion: The overall prevalence of CAD among patients undergoing non-coronary cardiac surgery is 8.7%. Coronary artery disease is relatively uncommon in patients with rheumatic VHD (4.9%, while its prevalence is highest in DAVD (23.4%.

  11. A different kind of Christmas tree: anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA).

    Science.gov (United States)

    Afolabi-Brown, Olayinka; Witzke, Christian; Moldovan, Raul; Pressman, Gregg

    2014-02-01

    Anomalous right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly that has an incidence of 0.002%. We report a case of a previously healthy female who presented to our hospital with pneumonia and was incidentally discovered to have ARCAPA. This was initially diagnosed on echocardiography by the unusual echocardiographic finding of multiple color flow Doppler signals around the right ventricular free wall and apex which were subsequently confirmed by angiography to be due to extensive collateral circulation between the left and right coronary arteries. This represents an unusual echocardiographic manifestation of this very rare condition. © 2013, Wiley Periodicals, Inc.

  12. The association between uric acid levels and different clinical manifestations of coronary artery disease

    DEFF Research Database (Denmark)

    Larsen, Trine R; Gerke, Oke; Diederichsen, Axel C P

    2018-01-01

    AIMS: Uric acid (UA) has been associated with the presence and severity of coronary artery disease. To further assess the role of UA role in coronary artery disease, we investigated UA levels in both healthy asymptomatic middle-aged individuals and in different subgroups of hospitalized patients...

  13. Electrical neuromodulation for disabling angina pectoris related to isolated stenoses of small epicardial coronary arteries

    NARCIS (Netherlands)

    Jessurun, GAJ; Hautvast, RWM; DeJongste, MJL; Meyler, WJ; van Boven, AJ; Crijns, HJGM

    Patients with symptomatic small vessel coronary artery disease may be inadequate candidates for revascularization procedures. They may suffer from refractory angina, which does not respond to maximal anti-anginal drug therapy. In addition to patients with end stage coronary artery disease and

  14. Cardiac symptoms before sudden cardiac death caused by coronary artery disease

    DEFF Research Database (Denmark)

    Jabbari, Reza; Risgaard, Bjarke; Holst, Anders G

    2013-01-01

    The aim of this nationwide case-control study was to identify and characterise symptoms before sudden death of young persons who had died due to coronary artery disease (CAD).......The aim of this nationwide case-control study was to identify and characterise symptoms before sudden death of young persons who had died due to coronary artery disease (CAD)....

  15. Anterolateral papillary muscle rupture after intervention of the right coronary artery.

    Science.gov (United States)

    Morris, Liam; Desai, Anand; Akkus, Nuri Ilker

    2015-11-01

    Rupture of the anterolateral papillary muscle following a right coronary artery occlusion is extremely rare, and when complicated by a right ventricular infarction, can be fatal. The literature on optimal management of this complication is limited. We present an unusual case of anterolateral papillary muscle rupture following intervention of the right coronary artery. Published by Elsevier España.

  16. Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality

    DEFF Research Database (Denmark)

    Williams, M. C.; Murchison, J. T.; Edwards, L. D.

    2014-01-01

    Background Coronary artery calcification is pathognomonic of coronary artery disease (CAD). Whether CAD in patients with COPD is linked to lung function, functional capacity and/or clinically relevant outcomes is unknown. The objective was to assess the association between CAD and disease severit...

  17. Control of drug treatment of chronic coronary artery disease: possibilities of a regional registry

    Directory of Open Access Journals (Sweden)

    Rachkova S.A.

    2016-03-01

    Full Text Available The article describes the results of the Register of hypertension, coronary artery disease, chronic heart failure (Register of AH, CAD, HF in the Ivanovo region in 2015. The frequency of prescribing of the main groups of drugs in patients with coronary artery disease was estimated.

  18. On-pump versus off-pump coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Houlind, Kim Christian

    2013-01-01

    Off pump coronary artery bypass surgery has been purported to be safer than conventional coronary artery bypass surgery performed using cardiopulmonary bypass. This theory was supported by a number of early series, but failed to be confirmed by a number of small, randomized controlled trials...

  19. Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease

    DEFF Research Database (Denmark)

    Møller, Christian H; Penninga, Luit; Wetterslev, Jørn

    2012-01-01

    Coronary artery bypass grafting (CABG) is performed both without and with cardiopulmonary bypass, referred to as off-pump and on-pump CABG respectively. However, the preferable technique is unclear.......Coronary artery bypass grafting (CABG) is performed both without and with cardiopulmonary bypass, referred to as off-pump and on-pump CABG respectively. However, the preferable technique is unclear....

  20. The relationship between total arterial revascularization and blood transfusion following coronary artery bypass grafting.

    Science.gov (United States)

    Djordjevic, Jasmina; Ngaage, Dumbor L

    2015-05-01

    Blood transfusion adversely affects the outcome of coronary artery bypass grafting (CABG), yet blood transfusion after CABG is still common. Total arterial revascularisation (TAR) is increasingly used in current practice but its impact on postoperative blood transfusion is not known. We reviewed the cardiothoracic and blood bank databases and collected data for isolated primary CABG patients from July 2007 to June 2012, excluding patients who had a single graft (n = 148). Perioperative variables of TAR patients (n = 745) were compared with patients who had one or more venous grafts (SVG, n = 1,761) for first-time isolated CABG. The conduits used in TAR patients were predominantly left internal thoracic and radial arteries. Matched group comparison of TAR and SVG patients was performed. The association of TAR with blood transfusion was investigated using multivariate and matched analysis. Of 2,506 patients, the 745 (29.7 %) that had TAR were generally younger, with less complex coronary artery disease and less often diabetic. After correcting for these by 1:1 matching, the mean chest tube drainage and rates of blood transfusion remained significantly lower (p transfused in TAR patients. By multivariate analysis, TAR had an independent effect on reducing blood transfusion after CABG [odds ratio (OR) 0.67, 95 % confidence interval (CI) 0.47-0.97, p = .03]. TAR achieved predominantly with left internal thoracic and radial arteries substantially reduced blood transfusion rates after primary CABG. Further studies are warranted.

  1. Anatomical-clinical investigations of variations of the human coronary arteries

    OpenAIRE

    Aida Hasanović; Faruk Dilberović; Fehim Ovčina

    2003-01-01

    Variations of the human coronary arteries have always attracted the attention of many researchers. A review of the literature shows that variations can cause ischemic heart disease or sudden cardiac death. The aim of the investigations was to examine the existence and clinical significance of variations of the human coronary arteries. Special attention has been focused on myocardial bridging of the coronary arteries and coronary arteriovenous fistula. Our investigations were carried out on th...

  2. 78. Coronary bypass using bilateral internal mammary arteries in an achondroplast

    Directory of Open Access Journals (Sweden)

    Mohamed Abdulwahab Alassal

    2015-10-01

    Full Text Available Coronary bypass grafting for ischemic heart disease in achondroplastic dwarfs is very rare. Shortage of veins and sometimes, inadequate vein quality can cause difficulties during surgery. Only two achondroplastic cases were reported in literature that underwent coronary bypass surgery, in which the left internal mammary artery and vein grafts were used. To the best of our knowledge using bilateral internal mammary arteries in such patients was not reported. We report here a 55 years old male achondroplastic dwarf who had triple vessels coronary disease that underwent successful coronary bypass surgery using bilateral mammary arteries. Anatomic and surgical challenges in achondroplasia are highlighted

  3. Platelet hyperreactivity in response to on- and off-pump coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Bochsen, Louise; Rosengaard, Lisbeth Bredahl; Nielsen, Allan Bybeck

    2009-01-01

    Hypercoagulability has been reported after off-pump coronary artery bypass grafting (OPCAB) compared with patients undergoing standard coronary artery bypass grafting (CABG) with cardiopulmonary bypass. The aim of this study was to evaluate the changes in platelet reactivity in response to cardiac...... and this study identified 23% of patients needing coronary bypass surgery to be at high risk for recurrent ischemic events at 1 month after surgery, based on the MA. These results suggest that a more aggressive antithrombotic treatment might be warranted for patients undergoing coronary artery bypass grafting...

  4. Cognitive outcomes in elderly high-risk patients after off-pump versus conventional coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Jensen, Birte Ostergaard; Hughes, Pia; Rasmussen, Lars S

    2006-01-01

    It has been suggested that the risk of cerebral dysfunction is less with off-pump coronary artery bypass grafting (OPCAB) than with conventional coronary artery bypass grafting (CCAB). However, evidence for this statement is preliminary, and additional insight is needed.......It has been suggested that the risk of cerebral dysfunction is less with off-pump coronary artery bypass grafting (OPCAB) than with conventional coronary artery bypass grafting (CCAB). However, evidence for this statement is preliminary, and additional insight is needed....

  5. Left ventricular microfistulization: A rare cause of ischemia in a patient with normal coronary arteries

    Directory of Open Access Journals (Sweden)

    İsmet Dindar

    2012-06-01

    Full Text Available A 71-year-old woman with chest pain occurring on physicalexercise was admitted to cardiology department.Myocardial perfusion scintigraphy revealed inferior andanteroapical segment hypoperfusion. Selective coronaryangiography revealed multiple coronary-cameral fistulasoriginating from the left anterior descending artery andthe right coronary artery and emptying into the left ventriclewithout any significant coronary artery stenosis. Coronaryartery fistulas are defined as abnormal communicationsbetween a coronary artery and a cardiac chamber ormajor vessel. Coronary-cameral fistulas terminating in theleft ventricle are uncommon. Small fistulas usually do notcause any hemodynamic compromise. However, the largerand multiple fistulas may cause myocardial ischemiaascribed to a coronary steal phenomenon. The best wayto manage cameral fistulae is uncertain largely due to therarity of the condition. In the present case, anti-ischemicmedications with metoprolol 50 mg/day provided an uneventfulfollow-up of six months without any intervention.

  6. Is there a role for robotic totally endoscopic coronary artery bypass in patients with a colostomy?

    Science.gov (United States)

    Gibber, Marc; Lehr, Eric J; Kon, Zachary N; Wehman, P Brody; Griffith, Bartley P; Bonatti, Johannes

    2014-01-01

    Preoperative colostomy presents a significant risk of sternal wound complications, mediastinitis, and ostomy injury in patients requiring coronary artery bypass grafting. Less invasive procedures in coronary surgery have a potential to reduce the risk of sternal wound healing problems. Robotic totally endoscopic coronary artery bypass grafting in patients with a colostomy has not been reported. We describe a case of completely endoscopic coronary surgery using the da Vinci Si system in a patient with a transverse colostomy. Single left internal mammary artery grafting to the left anterior coronary artery was performed successfully on the beating heart. We regard this technique as the least invasive method of surgical coronary revascularization with a potential to reduce the risk of surgical site infection and mediastinitis in patients with a colostomy.

  7. A rare case of anomalous origin of the left main coronary artery in an adult patient

    Directory of Open Access Journals (Sweden)

    Dionne Pierre O

    2013-01-01

    Full Text Available Abstract Anomalous origin of left coronary artery from the pulmonary artery (ALCAPA is a rare congenital anomaly that causes a left-to-right shunt via the coronary system, resulting in coronary steal. We report an unusual case of a healthy 48 years-old patient presenting with dyspnea on exertion and mild chest pain who underwent surgical correction of this rare anomaly. Multiple procedures have been proposed in adults with ALCAPA. Although re-implantation of the left main coronary artery (LMCA to the aorta remains the most physiological correction for this anomaly, the combination of LMCA ligation and coronary artery bypass grafting provides a dual coronary flow system and is preferable when re-implantation is impossible.

  8. Anomalous Origin of the Left Coronary Artery from the Right Sinus of Valsalva and Sever Mitral Stenosis

    Science.gov (United States)

    Abdi, Ahmadnoor; Hashemi Fard, Omid

    2011-01-01

    Congenital coronary anomalies are presented in approximately1% of patient referred for cardiac catheterization. Among the congenital coronary anomalies, a separated anomalous origin of all the coronary arteries from the right sinus of valsalva is very uncommon. We report a rare occurance of simultaneous occurence of mitral stenosis with ectopic origin of left main stem coronary artery from right sinus of Valsalva. PMID:22577434

  9. [Developments in percutaneous coronary intervention and coronary stents].

    Science.gov (United States)

    Simsek, C; Daemen, J; Zijlstra, F

    2014-01-01

    In The Netherlands, more than 30.000 patients undergo a percutaneous coronary intervention every year, during which a coronary stent implantation will be performed in 90% of the cases. It is estimated that more than 5 million coronary stent implantations will be performed worldwide this year. While these numbers are impressive, however, coronary stents still have as a limitation the possibility of stent thrombosis. This has been and is an important stimulus for the development of both coronary stents, from a bare metal stent via a drug eluting stent to the present-day development of bio-absorbable stents, and anti-platelet drugs,from acenocoumarol to thieropyridines. The possibility of shortening the period of use of this powerful medication by developing new kinds of non-thrombogenic stents would, for example, make it possible to achieve significant reductions in subsequent bleeding during (dental) procedures.

  10. Bland-White-Garland syndrome of anomalous left coronary artery arising from the pulmonary artery (ALCAPA): a historical review

    International Nuclear Information System (INIS)

    Cowles, Robert A.; Berdon, Walter E.

    2007-01-01

    The landmark 1933 case report from Massachusetts General Hospital by Bland, White and Garland (Am Heart J 8:787-801) described a 3-month-old child with progressive feeding problems, cardiomegaly on chest radiography, and EKG evidence of left ventricular damage. Of interest was the fact that the vigilant father of the infant was Aubrey Hampton, a radiologist and future chairman of radiology at Massachusetts General Hospital. At autopsy, the left coronary artery originated from the pulmonary artery rather than from the aorta. Effective treatment for this condition was not available until 1960 when Sabiston, Neill and Taussig showed that the blood flowed from the left coronary artery toward the pulmonary artery. The anomalous left coronary artery was ligated at its junction with the pulmonary artery and the child survived. This historical review of Bland-White-Garland syndrome, now known as anomalous left coronary artery arising from the pulmonary artery (ALCAPA), stresses the continued diagnostic significance of cardiomegaly on chest radiography and EKG changes suggesting left ventricular damage in 2- to 3-month-old infants with feeding intolerance or irritability. With a high index of suspicion, an echocardiogram can be obtained to confirm the diagnosis. Modern surgical methods involve left coronary artery translocation and afford excellent outcomes. (orig.)

  11. Fifteen new risk loci for coronary artery disease highlight arterial wall-specific mechanisms

    OpenAIRE

    Howson, Joanna M.M.; Zhao, Wei; Barnes, Daniel R.; Ho, Weang-Kee; Young, Robin; Paul, Dirk S.; Waite, Lindsay L.; Freitag, Daniel F.; Fauman, Eric B.; Salfati, Elias L.; Sun, Benjamin B.; Eicher, John D.; Johnson, Andrew D.; Sheu, Wayne H.H.; Nielsen, Sune F.

    2017-01-01

    Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Although 58 genomic regions have been associated with CAD thus far, most of the heritability is unexplained, indicating that additional susceptibility loci await identification. An efficient discovery strategy may be larger-scale evaluation of promising associations suggested by genome-wide association studies (GWAS). Hence, we genotyped 56,309 participants using a targeted gene array derived from earlier G...

  12. Fifteen new risk loci for coronary artery disease highlight arterial-wall-specific mechanisms

    OpenAIRE

    Howson, Joanna McCammond; Zhao, W; Barnes, Daniel Robert; Ho, W-K; Young, R; Paul, Dirk Stefan; Waite, LL; Freitag, DF; Fauman, EB; Salfati, EL; Sun, Benjamin; Eicher, JD; Johnson, AD; Sheu, WHH; Nielsen, SF

    2017-01-01

    Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Although 58 genomic regions have been associated with CAD thus far, most of the heritability is unexplained, indicating that additional susceptibility loci await identification. An efficient discovery strategy may be larger-scale evaluation of promising associations suggested by genome-wide association studies (GWAS). Hence, we genotyped 56,309 participants using a targeted gene array derived from earlier G...

  13. EFFECT OF ASCORBIC ACID ON THE RIGHT AND LEFT CORONARY ARTERIES OF MALE RABBITS FED WITH HIGH-CHOLESTEROL DIET

    Directory of Open Access Journals (Sweden)

    Gholamreza Dashti

    2010-12-01

    Full Text Available   Abstract INTRODUCTION: Atherosclerosis and cardiovascular diseases are the most common causes of death in western countries. The beneficial effect of ascorbic acid on various organs has been reported. The present study was conducted to determine the effect of ascorbic acid on the right and left coronary arteries of male rabbits fed with high-cholesterol diet. methods: Twenty white male rabbits (mean weight: 950 g were weighed and randomly divided into two groups. For 40 days, group 1 (n=10 was given a high-cholesterol (1% diet, group 2 (n=10 was fed with a high-cholesterol diet and ascorbic acid (100 mg/kg. Then both of the groups were weighed and the animals were sacrificed. The right and left coronary arteries were dissected and then fixation, tissue processing, histological sectioning and H & E staining were carried out and sections were studied by light microscopy. The results were analyzed by using the Mann Whitney test. results: Group 2 which received ascorbic acid had no fatty streaks in their coronary arteries. Significant difference in mean weight was observed before and after the diet in both groups (P<0.05. CONCLUSIONS: Histopathological study of the coronary arteries showed that the rabbits which received ascorbic acid diet did not develop fatty streaks. Thus ascorbic acid exerts an apparently inhibitory effect on fatty streak formation and may slow down or prevent atherosclerosis by countering the side effects of a high-fat meal.     Keywords: Ascorbic acid, cholesterol, coronary arteries.

  14. The clinical research of off-pump coronary artery bypass grafting by small incision at the left chest.

    Science.gov (United States)

    Xiao, L-B; Zhang, Y-H; Zhou, J-W; Yang, M; Ling, Y-P; Gao, Z-S; Wang, Y-S

    2016-01-01

    To explore the clinical value of off-pump coronary artery bypass grafting by small incision at the left chest, and develop a better surgical regimen for coronary heart disease patients. 201 coronary heart disease patients who need coronary artery bypass grafting were required and randomly divided into 2 groups including a control group and an observation group. There were 107 cases in the control group who received coronary bypass grafting by extracorporeal circulation; there were 103 cases in the observation group who received off-pump coronary bypass grafting by small incision at the left chest. The duration of the mechanism ventilation, length of stay in ICU, hospitalization time, postoperative drainage volume, and the occurrence rate of complications were recorded and compared. The duration of mechanism ventilation, length of stay in ICU, hospitalization time and postoperative drainage volume in the control group were (19.21 ± 1.33) hours, (5.08 ± 0.57) days, (21.20 ± 2.34) days and (997.68 ± 96.35) mL, which were (7.73 ± 0.74) hours, (2.83 ± 0.16) days, (15.67 ± 1.18) days and (901.53 ± 89.32) mL in the observation group respectively, with statistical difference between the two groups (pdisease, pulmonary infection, perioperative cardiac infarction and mortality did not display a significant difference between the two groups (p > 0.05). Off-pump coronary artery bypass grafting by small incision at the left chest is a surgical method with less injury and fast recovery, which can be used as the preferred therapeutical method for the coronary heart disease patients who need coronary artery bypass grafting.

  15. Percutaneous coronary intervention versus coronary artery bypass grafting: where are we after NOBLE and EXCEL?

    Science.gov (United States)

    Fortier, Jacqueline H; Shaw, Richard E; Glineur, David; Grau, Juan B

    2017-11-01

    The publication of the NOBLE and EXCEL trials, with seemingly conflicting results, brought into question whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is better for low-risk patients with left main coronary artery stenosis (LMCAS). This review appraises the methods and results of NOBLE and EXCEL, contextualizes them within the literature, and determines how they may affect clinical practice. We appraised the trials and describe differences in methodology and results. NOBLE recruited primarily isolated LMCAS, and found that CABG was superior to PCI. EXCEL's population included patients LMCAS in the context of multivessel CAD, and found PCI and CABG were comparable. Both trials enrolled young patients with few comorbidities, and there was more protocol-mandated consistency in the procedural techniques and medical therapy of patients receiving PCI. The generalizability of these trials is limited by the use of young, healthy patients at highly skilled centres that rarely reflect typical clinical practice. If these studies are to maintain relevance, trialists must address the lack of protocolization of surgical interventions and inconsistent medical therapies. Unfortunately, the limitations of NOBLE and EXCEL mean that we are no closer to answering the question of what is the optimal treatment for patients with LMCAS.

  16. The clinical usefulness evaluation of normal saline injection in coronary artery computed tomography angiography (Coronary CTA)

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Kang Kyo; Lee, Mi Hwa; Cho, Pyong Kon [Dept. of Radiological Science, Catholic University of Daegu, Daegu (Korea, Republic of)

    2014-12-15

    The purpose of this study is that in coronary artery angiography computed tomography (coronary CTA), to gain high quality of image and to use low dose radiation by administrating normal saline and converting the mode of scanning heart rate (HR) characteristics before infusing contrast media. All patients data (total specimens: 200, male: 108, female: 92) were measured by using appropriate mode of scanning the heart rate (HR) after injection of saline. in addition we measured radiation dose (CTDIvol, effective dose) in all examinations. CT number and noise, and blurring of coronary artery (proximal RCA, middle RCA, proximal LCA) were measured and compared. The result of this study after injection of saline, mean heart rate was decreased about 4.8±0.3 bpm (beats per minute). 33 patients (13%) got converting scan mode due to reducing heart rate (HR). In prospective gating mode, radiation dose were measured less 6.0±1.0 mSv (54.1%) than retrospective gating mode. Also showed a significant difference in heart rate decrease in image evaluation.

  17. The clinical usefulness evaluation of normal saline injection in coronary artery computed tomography angiography (Coronary CTA)

    International Nuclear Information System (INIS)

    Jung, Kang Kyo; Lee, Mi Hwa; Cho, Pyong Kon

    2014-01-01

    The purpose of this study is that in coronary artery angiography computed tomography (coronary CTA), to gain high quality of image and to use low dose radiation by administrating normal saline and converting the mode of scanning heart rate (HR) characteristics before infusing contrast media. All patients data (total specimens: 200, male: 108, female: 92) were measured by using appropriate mode of scanning the heart rate (HR) after injection of saline. in addition we measured radiation dose (CTDIvol, effective dose) in all examinations. CT number and noise, and blurring of coronary artery (proximal RCA, middle RCA, proximal LCA) were measured and compared. The result of this study after injection of saline, mean heart rate was decreased about 4.8±0.3 bpm (beats per minute). 33 patients (13%) got converting scan mode due to reducing heart rate (HR). In prospective gating mode, radiation dose were measured less 6.0±1.0 mSv (54.1%) than retrospective gating mode. Also showed a significant difference in heart rate decrease in image evaluation

  18. Coronary artery aneurysms in acute coronary syndrome: case series, review, and proposed management strategy.

    Science.gov (United States)

    Boyer, Nathan; Gupta, Rajesh; Schevchuck, Alex; Hindnavis, Vindhya; Maliske, Seth; Sheldon, Mark; Drachman, Douglas; Yeghiazarians, Yerem

    2014-06-01

    Coronary artery aneurysm (CAA) is an uncommon clinical finding, with an incidence varying from 1.5%-4.9% in adults, and is usually considered a variant of coronary artery disease (CAD). CAA identified in the context of acute coronary syndrome (ACS) represents a unique management challenge, particularly if the morphology of the CAA is suspected to have provoked the acute clinical syndrome. CAA is associated with thrombus formation due to abnormal laminar flow, as well as abnormal platelet and endothelial-derived pathophysiologic factors within the CAA. Once formed, mural thrombus may potentiate the deposition of additional thrombus within aneurysmal segments. Percutaneous revascularization of CAA has been associated with complications including distal embolization of thrombus, no-reflow phenomenon, stent malapposition, dissection, and rupture. Presently, there are no formal guidelines to direct the management of CAA in patients presenting with ACS; controversies exist whether conservative, surgical, or catheter-based management should be pursued. In this manuscript, we present an extensive review of the existing literature and associated clinical guidelines, and propose a management algorithm for patients with this complex clinical scenario. Armed with this perspective, therapeutic decisions may be tailored to synthesize patient factors and preferences, individualized clinical assessment, and existing American Heart Association/American College of Cardiology guidelines for management of ACS.

  19. Efficacy of Patient Selection for Diagnostic Coronary Angiography in Suspected Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Francisco Flávio Costa Filho

    2015-11-01

    Full Text Available AbstractBackground:Guidelines recommend that in suspected stable coronary artery disease (CAD, a clinical (non-invasive evaluation should be performed before coronary angiography.Objective:We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD.Methods:We prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests.Results:A total of 830 patien